Abstract
Is Isolation of Arrhythmogenic Pulmonary Veins sufficient for The Long-term Efficacy of Atrial Fibrillation Ablation?
Highlights
Atrial fibrillation (AF) is the commonest cardiac rhythm disorder, affecting about 5% of elderly patients.[1]
Evident is an increase in the frequency of pulmonic vein firing (PVF) with and without conduction out of the vein resulting in atrial premature complexes
We have developed a methodology for using activation patterns of multipolar catheters in locations distant from the pulmonary veins (PV) which can help in localizing the culprit vein.[36,37]
Summary
Atrial fibrillation (AF) is the commonest cardiac rhythm disorder, affecting about 5% of elderly patients.[1]. An alternative explanation for the enhanced success of PVI is that the procedure inadvertently targets LA tissue (around PV os) and so results in modification of the underlying substrate This hypothesis has been supported by the observation that anatomically guided circumferential PV ostial ablation without necessarily achieving true PVI (entry / exit block) is efficacious in achieving long term AF control.[5,6] this observation has led to the development of an anatomically guided incremental ablation strategy which attempts to substantially modify the AF substrate by extensive LA ablation.[14,15,16] such an approach has not consistently demonstrated a significant improvement in long term AF control rates as compared with PVI alone, which would suggest that PVs may be critical to the initiation and / or maintenance of AF.[18,19] The purpose of this editorial is to provide the readers with a concise overview on the arrhythmogenic potential of PVs and to discuss how best we can identify and target such veins and whether that translates into long term control of AF.
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