Substrate Modification by Pulmonary Vein Isolation and Left Atrial Linear Ablation in Patients with Persistent Atrial Fibrillation: Its Impact on Complex‐Fractionated Atrial Electrograms

Abstract

Both PV isolation and LA linear ablations diminished the CFAEs in PsAF patients, suggesting substrate modification by PV and linear ablations. (J Cardiovasc Electrophysiol, Vol. 23, pp. 962-970, September 2012).

Catheter Ablation of Lone Atrial Fibrillation

“…Completeness and transmurality of linear lesions are very important for the successful treatment of AF as well as for the prevention of iatrogenic atrial tachycardia after ablation [54]. Linear ablation leads to compartmentalization of the LA and reduction of the area with CFAE, thus resulting in an additional AF cycle length increase, which can be critical for the AF termination during a stepwise approach to the ablation of longstanding persistent AF [55]. Ganglionated plexi are usually located 1-2 cm outside the LA-PV junctions at the left superolateral, right superoanterior, left inferoposterior and right inferoposterior area, and it has been shown that their anatomical RF ablation is accompanied by substantial AF substrate modification [56].…”

Impact of Stepwise Ablation on the Biatrial Substrate in Patients With Persistent Atrial Fibrillation and Heart Failure

“…21 This may be related to the CFE mapping methods used, although could reflect a substrate with more disparate islands of CFE, as similarly reported by Jadidi et al 23 in patients with persistent AF and dilated atria, compared with the confluent CFE reported in lone AF in smaller atria. 10,21 However, the relative reduction of remote CFE postablation was similar to earlier studies.…”

“…Stepwise ablation, including PVI, CFE targeting, and linear lesions, can lead to favorable outcomes. 7,8 If one intends to ablate CFE, our data support following PVI with linear lesions to minimize unnecessary CFE ablation, 21 which itself may be proarrhythmic. 26 Some CFE may facilitate ongoing AF 3 ; in our study, ablation of residual LA CFE after linear ablation prolonged AF CL and terminated AF in a handful of cases.…”

“…9,10 More recently, Matsuo et al 21 showed that in patients with mostly lone AF, linear lesions additionally reduced CFE at remote LA sites. These studies examined patients without significant structural heart disease and minimal atrial dilatation (mean 40-45 mm).…”

Pearls and Pitfalls in Catheter Ablation of Persistent Atrial Fibrillation

“…22, 23 Matsuo et al reported that in patients with persistent AF, PV isolation with LA linear ablation diminished the CFAE area in regions remote from the ablation sites. 24 Pak et al proposed that linear ablation along the LA anterior wall results in a better clinical outcome in persistent AF patients, with a higher rate of bidirectional block compared with lateral mitral isthmus ablation. 25 However, linear ablation is a double-edged sword because proarrhythmic atrial tachycardias can be created secondary to an incomplete block line.…”