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MINERVA CARDIOANGIOLOGICA

A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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REVIEW  MANAGEMENT OF CARDIAC ARRHYTHMIAS


Minerva Cardioangiologica 2018 February;66(1):63-74

DOI: 10.23736/S0026-4725.17.04430-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Targeting ablation strategies and electro-anatomical systems for different atrial fibrillation patterns

Francesco SANTORO 1, 2 , Christian H. HEEGER 1, Andreas METZNER 1, Natale D. BRUNETTI 2, Matteo DI BIASE 2, Karl-Heinz KUCK 1, Feifan OUYANG 1

1 Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; 2 Department of Medical and Surgery Science, University of Foggia, Foggia, Italy


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INTRODUCTION: Catheter ablation (CA) is an established and widespread treatment option for drug refractory atrial fibrillation (AF). CA has undergone considerable improvements during the last years and several ablation strategies have been proposed for different AF patterns.
EVIDENCE ACQUISITION: The main cornerstone is the electrical isolation of pulmonary veins (PVs) especially among patients with paroxysmal AF. This can be achieved mainly with the use of radiofrequency or cryo-energy. However ablation strategy remains uncertain in patients with persistent AF.
EVIDENCE SYNTHESIS: Several mapping systems have been developed in order to acquire electrical and anatomical information of the left and right atrium. For patients with persistent atrial fibrillation new systems are able to identify potential AF triggers arising out of the PVs, but the role of ablation of this triggers is still not clear.
CONCLUSIONS: Although several improvements have been performed in CA of AF, the main cornerstone of treatment remains the electrical isolation of PVs. This approach provides good clinical results at long-term follow-up in patients with paroxysmal AF. However, the ablation strategy apart from electrical isolation of PV in patients with persistent AF is still not well defined. Further improvement of mapping systems could provide more information about alternative ablation strategies.


KEY WORDS: Atrial fibrillation - Catheter ablation - Pulmonary veins

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Publication History

Issue published online: December 7, 2017
Article first published online: May 25, 2017
Manuscript accepted: May 23, 2017
Manuscript received: May 9, 2017

Cite this article as

Santoro F, Heeger CH, Metzner A, Brunetti ND, Di Biase M, Kuck KH, et al. Targeting ablation strategies and electro-anatomical systems for different atrial fibrillation patterns. Minerva Cardioangiol 2018;66:63-74. DOI: 10.23736/S0026-4725.17.04430-9

Corresponding author e-mail

dr.francesco.santoro.it@gmail.com