Atrial Fibrillation Ablation Strategies for Paroxysmal Patients

Biase, Luigi Di; Elayi, Claude S.; Fahmy, Tamer S.; Martin, David O.; Ching, Chi Keong; Barrett, Conor D.; Bai, Rong; Patel, Dimpi; Khaykin, Yaariv; Hongo, Richard; Sheng, Hao; Beheiry, Salwa; Pelargonio, Gemma; Russo, Antonio Dello; Casella, Michela; Santarelli, P; Potenza, Domenico; Fanelli, Raffaele; Massaro, Rosalba; Wang, Paul; Al‐Ahmad, Amin; Arruda, Maurício; Themistoclakis, Sakis; Bonso, Aldo; Rossillo, Antonio; Raviele, Antonio; Schweikert, Robert A.; Burkhardt, David; Natale, Andrea

doi:10.1161/circep.108.798447

Cited by 127 publications

(88 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…62 Di Biase et al randomised 103 patients with paroxysmal AF to CFAE ablation, PVI, or the combination of CFAE ablation and PVI and found that freedom from atrial tachyarrhythmia at one year was present in only 23 % of patients who underwent CFAE ablation alone compared with 89 % in the PVI group, and 91 % in the CFAE plus PVI group (p<0.001 for a three-way comparison). 63 Interest thus shifted to using CFAE ablation as an adjunctive procedure during standard PVI. Elayi et al randomised 144 patients with long-standing permanent AF to circumferential pulmonary vein ablation, antral PVI or CFAE ablation followed by PVI.…”

Section: Limitations Of Targeting Rotors With Ablation For the Treatmmentioning

confidence: 99%

“…65 Multiple other studies, however, have found that targeting CFAEs provided no additional freedom from AF over PVI alone even among patients with permanent AF. 57,59,60,63 A recent meta-analysis evaluated the outcomes in 622 patients across seven trials that compared PVI with PVI plus adjunctive CFAE ablation. It These studies of CFAE ablation support observations that patients with non-paroxysmal AF tend to have less success with conventional PVI alone, and they complement the previous data describing how patients with paroxysmal AF and non-paroxysmal AF appear to have variations in AF drivers.…”

Section: Limitations Of Targeting Rotors With Ablation For the Treatmmentioning

confidence: 99%

“…Observations that CFAE ablation without PVI results in very high rates of AF recurrence 54,[61][62][63]65 suggest that CFAEs are not drivers of AF. In fact, the vast majority of areas of observed fractionation are actually functional and passive electrophysiological manifestations.…”

Section: Complex Fractionated Electrograms Are Passive Bystanders In Afmentioning

confidence: 99%

See 2 more Smart Citations

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Atrial fibrillation (AF), the most common sustained arrhythmia, is a leading cause of stroke, and is associated with significant morbidity and mortality worldwide. Despite its frequency, clinical importance, and advances in technology and our knowledge of the molecular, ionic and physiological fundamentals of cardiac electrophysiology, our limited understanding of the mechanisms that initiate and sustain AF has prevented us from being able to truly cure this arrhythmia with antiarrhythmic drugs and/or ablation. This contrasts with other arrhythmias, such as AV nodal tachycardia or circus movement tachycardia using an accessory pathway, which have well-defined mechanisms and circuits that can be safely targeted with high rates of cure. The observations that AF may have different mechanisms in different patients, and that paroxysmal, persistent and permanent forms of AF may differ in how they are initiated and sustained, only serves to reinforce our lack of understanding of this ubiquitous arrhythmia. Historical Mechanisms of Atrial Fibrillation and the Multiple Wavelet HypothesisInterest and understanding of the mechanism of AF began to take form in the early 1900s. Given the chaotic and irregular nature of AF on the surface electrocardiogram, rapid firing of automatic atrial foci was considered a potential mechanism. However, after the seminal work of Mayer 1 , Mines 2 and Garrey 3 in laying the foundation for describing and understanding reentrant arrhythmias, atrial reentrant circuits emerged as the likely drivers of AF.4-7 Although these theories were conceptually sound, it was impossible to prove a specific mechanism with the technology of the time. Moe et al. demonstrated that it was probabilistically unlikely that a large number of simultaneous wavefronts would all die out simultaneously, and AF would therefore perpetuate. However, if the number of simultaneous wavelets were small and/or below a critical value (between 15 and 30 in Moe's computer model), 9 at some point all reentrant wavefronts would be simultaneously extinguished, and AF would therefore terminate. 8,9 Allessie et al. provided experimental evidence supporting this mechanism in a canine heart model of AF where four to six simultaneous reentrant wavelets were needed to sustain arrhythmia. 10 Further evidence supporting multiple wavelets in AF was demonstrated in a separate model, which evaluated the effect of various antiarrhythmic drugs on canine myocardium. This model demonstrated that termination of AF was associated with a reduction AbstractAtrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, yet our understanding of the mechanisms that initiate and sustain this arrhythmia remains quite poor. Over the last 50 years, various mechanisms of AF have been proposed, yet none has been consistently observed in both experimental studies and in humans. Recently, there has been increasing interest in understanding how spiral waves or rotors -which are specific, organised forms of functional reentry -su...

show abstract

Section: Limitations Of Targeting Rotors With Ablation For the Treatmmentioning

confidence: 99%

Section: Limitations Of Targeting Rotors With Ablation For the Treatmmentioning

confidence: 99%

See 1 more Smart Citation

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Waks

Josephson²

2014

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

show abstract

“…[19] Nevertheless, antral isolation is evidently effective to treat patients with paroxysmal AF when compared with CAFÉ defragmentation. [20] Interestingly, complex fractionations in normal atrial voltages may only represent the response of healthy atrial tissue to rapid pulmonary veins activation rather than a substrate to AF. [21] Recovery of conduction in previously ablated muscle fascicles in the antrum is a common finding in patients with recurrent AF.…”

Section: Resultsmentioning

confidence: 99%

High Voltage Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Boles

Gül

Enríquez

et al. 2017

Journal of Atrial Fibrillation

View full text Add to dashboard Cite

“…90%). 1 Recent evidence suggests that complete circumferential antral ablation is not even necessary for PV isolation. 2 When AF persists beyond one week, electrical and anatomic substrate remodeling typically occurs.…”

Section: Introductionmentioning

confidence: 99%

Ablation of Long-Standing Persistent Atrial Fibrillation

Ciaccio¹

2010

J.A.F.I.B

View full text Add to dashboard Cite

Atrial Fibrillation Ablation Strategies for Paroxysmal Patients

Cited by 127 publications

References 19 publications

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

Mechanisms of Atrial Fibrillation – Reentry, Rotors and Reality

High Voltage Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Ablation of Long-Standing Persistent Atrial Fibrillation

Contact Info

Product

Resources

About