Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans. 1 Feinberg W.M. Blackshear J.L. Laupacis A. Kronmal R. Hart R.G. Prevalence, age distribution, and gender of patients with atrial fibrillation. Arch Intern Med. 1995; 155: 469-473 Crossref PubMed Scopus (1952) Google Scholar It also is the most common cardiac cause of stroke 2 Wolf P.A. Abbot R.D. Kannel W.B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22: 983-988 Crossref PubMed Scopus (5650) Google Scholar and can result in additional adverse outcomes. 3 Schumacher B. Luderitz B. Rate issues in atrial fibrillation: consequences of tachycardia and therapy for rate control. Am J Cardiol. 1998; 82: 29N-36N Abstract Full Text Full Text PDF PubMed Google Scholar Antiarrhythmic drugs are only partially effective in treating AF, and they have the potential for serious side effects, including life-threatening proarrhythmia. On the other hand, it recently has been demonstrated that paroxysmal AF in patients is initiated by focal triggers localized usually to one of the pulmonary veins (PVs) 4 Haissaguerre M. Jais P. Shah D.C. Takahashi A. Hocini M. Quiniou G. Garrigue S. Le Mouroux A. Le Metayer P. Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998; 339: 659-666 Crossref PubMed Scopus (6265) Google Scholar and can be cured by a catheter-based ablation procedure. 5 Haissaguerre M. Shah D.C. Jais P. Hocini M. Yamane T. Deisenhofer I. Garrigue S. Clementy J. Mapping-guided ablation of pulmonary veins to cure atrial fibrillation. American Journal of Cardiology. 2000; 86: 9K-19K Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar However, in persistent AF, the prevailing theory is that multiple random wavelets of activation coexist to create a chaotic cardiac rhythm, 6 Moe G.K. Abildskov J.A. Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharges. Am Heart J. 1959; 58: 59-70 Abstract Full Text PDF PubMed Scopus (656) Google Scholar and therapy is more challenging. 7 Haissaguerre M. Jais P. Shah D.C. Arentz T. Kalusche D. Takahashi A. Garrigue S. Hocini M. Peng J.T. Clementy J. Catheter ablation of chronic atrial fibrillation targeting the reinitiating triggers. J Cardiovasc Electrophysiol. 2000; 11: 2-10 Crossref PubMed Scopus (196) Google Scholar , 8 Benussi S. Pappone C. Nascimbene S. Oreto G. Caldarola A. Stefano P.L. Casati V. Alfieri O. A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach. Eur J Cardiothorac Surg. 2000; 17: 524-529 Crossref PubMed Scopus (166) Google Scholar , 9 Knight B.P. Weiss R. Bahu M. Souza J. Zivin A. Goyal R. Daoud E. Man K.C. Strickberger S.A. Morady F. Cost comparison of radiofrequency modification and ablation of the atrioventricular junction in patients with chronic atrial fibrillation. Circulation. 1997; 96: 1532-1536 Crossref PubMed Scopus (27) Google Scholar , 10 Oral H. Pappone C. Chugh A. Good E. Bogun F. Pelosi Jr, F. Bates E.R. Lehmann M.H. Vicedomini G. Augello G. Agricola E. Sala S. Santinelli V. Morady F. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006; 354: 934-941 Crossref PubMed Scopus (805) Google Scholar
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