Atrial fibrillation ablation: From guidelines to clinical reality
Electrophysiologic Techniques, Cardiac
Ventricular Premature Complexes
© 2014 Springer-Verlag London. All rights reserved.Atrial fibrillation (AF) results in electrical and anatomical remodeling that leads to progression of the arrhythmia and deterioration in mechanical function. Catheter ablation has evolved as an effective treatment that can maintain sinus rhythm and alleviate symptoms in many patients. Randomized studies show that catheter ablation is superior to antiarrhythmic drug therapy in selected patients with AF, particularly those who have failed prior antiarrhythmic drug treatment. Guidelines currently support catheter ablation in patients who have recurrent AF despite treatment with an antiarrhythmic drug, and ablation is also considered reasonable in optimal candidates who have not been exposed to an antiarrhythmic drug. The cornerstone of ablation involves pulmonary vein isolation, because the proximal pulmonary veins harbor the most common triggers for paroxysmal AF. Adjunctive lesion sets may be required in patients with more advanced disease. Long-term studies of catheter ablation reveal a high recurrence rate of AF and atrial tachycardias, especially among those with persistent and long-lasting persistent AF, and multiple procedures may be required to achieve long-term control. Further investigation is needed to optimize lesions sets and procedural endpoints in order to minimize recurrences, to develop technologies to deliver better transmural lesions, and to develop techniques that further minimize procedure-related complications.
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