Skip to main content
SpringerLink
Log in

Ablation of permanent AF

Adjunctive strategies to pulmonary veins isolation: Targeting AF NEST in sinus rhythm and CFAE in AF

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Atrial fibrillation (AF) is highly prevalent and accounts for significant morbidity, mortality, and health care costs. Catheter ablation has become a therapeutic option in the management of this challenging arrhythmia. To optimize procedure safety and long-term efficacy, innovative technologies and ablation strategies have been targeting either the triggers initiating AF or the substrate responsible for its maintenance. Pulmonary vein (PV) isolation, initially limited to the PVs, has been modified to encompass the left atrial myocardium surrounding the PV ostia, namely the LA-PV antra. Our current intracardiac echo-guided approach to PV antra isolation, including the adjunct of superior vena cava isolation, has likely accounted for higher success rates by electrically isolating further AF trigger sites, modifying the substrate for AF maintenance and possibly by modulating a dysfunctional autonomic cardiac nervous system. However, the long-term outcome following ablation of permanent AF can be further improved by incorporating adjunctive ablation strategies to PV isolation, such as targeting ablation at sites exhibiting complex atrial fractionated electrograms (CFAEs)during AF or at sites exhibiting the so-called AF nests during real-time spectral mapping in sinus rhythm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Marrouche, N. F., Dresing, T., Cole, C., Bash, D., Saad, E., Balaban, K., et al. (2002). Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: Impact of different catheter technologies. Journal of the American College of Cardiology, 40(3), 464–474, (Aug 7).

    Article  PubMed  Google Scholar 

  2. Marrouche, N. F., Martin, D. O., Wazni, O., Gillinov, A. M., Klein, A., Bhargava, M., et al. (2003). Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: Impact on outcome and complications. Circulation, 107(21), 2710–2716, (Jun 3).

    Article  PubMed  Google Scholar 

  3. Verma, A., Marrouche, N. F., & Natale, A. (2004). Pulmonary vein antrum isolation: Intracardiac echocardiography guided technique. Journal of Cardiovascular Electrophysiology, 15(11), 1335–1340.

    Google Scholar 

  4. Bhargava, M., Marrouche, N., Martin, D., Burghardt, D., Khaykin, Y., Joseph, G., et al. (2004). Chronic cure rate after pulmonary vein isolation in patients with nonparoxysmal atrial fibrillation: Impact of a second ablation. Journal of the American College of Cardiology, 43(5), 133A.

    Article  Google Scholar 

  5. Arruda, M., & Natale, A. (2006). The adjunctive role of nonpulmonary venous ablation in the cure of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 17(3), 37.

    Article  Google Scholar 

  6. Arruda, M., Mlcochova, H., Prasad, S., Kilicaslan, F., Saliba, W., Patel, D., et al. (2007). Electrical isolation of the superior vena cava: An adjunctive strategy to pulmonary vein antrum isolation—Improving the outcome of AF ablation. Journal of Cardiovascular Electrophysiology 18, 1261–1266.

    Google Scholar 

  7. Konings, K. T., Smeets, J. L., Penn, O. C., Wellens, H. J., & Allessie, M. A. (1997). Configuration of unipolar atrial electrograms during electrically induced atrial fibrillation in humans. Circulation, 95(5), 1231–1241.

    PubMed  CAS  Google Scholar 

  8. Jais, P., Haissaguerre, M., Shah, D. C., Chouairi, S., & Clementy, J. (1996). Regional disparities of endocardial atrial activation in paroxysmal atrial fibrillation. Pacing and Clinical Electrophysiology, 19(11 Pt 2), 1998–2003.

    Article  PubMed  CAS  Google Scholar 

  9. Nademanee, K., McKenzie, J., Kosar, E., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., et al. (2004). A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. Journal of the American College of Cardiology, 43(11), 2044–2053.

    Article  PubMed  Google Scholar 

  10. Oral, H., Chugh, A., Good, E., Igic, P., Elmouchi, D., Tschopp, D. R., et al. (2005). Randomized comparison of encircling and nonencircling left atrial ablation for chronic atrial fibrillation. Heart Rhythm, 2(11), 1165–1172.

    Article  PubMed  Google Scholar 

  11. Haissaguerre, M., Sanders, P., Hocini, M., Takahashi, Y., Rotter, M., Sacher, F., et al. (2005). Catheter ablation of long-lasting persistent atrial fibrillation: Critical structures for termination. Journal of Cardiovascular Electrophysiology, 16(11), 1125–1137.

    Article  PubMed  Google Scholar 

  12. Nakagawa, H., Jackman, W., Scherlag, B., Yokoyama, K., Wu, R., Oza, S., et al. (2005). Relationship of complex fractionated atrial electrograms during atrial fibrillation to the location of cardiac automatic ganglionated plexi in patients with atrial fibrillation. Circulation, 112(17), II–746.

    Google Scholar 

  13. Pachon, M. J. C., Pachon, M. E. I., Pachon, M. J. C., Lobo, T. J., Pachon, M. Z., Vargas, R. N., et al. (2004). A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation. Europace, 6(6), 590–601.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Electrophysiology and Atrial Fibrillation Center, University Hospitals Heart & Vascular Institute, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH, 44106, USA

    Mauricio Arruda

  2. Texas Cardiac Arrhythmias Institute, Austin, TX, USA

    Andrea Natale

Authors
  1. Mauricio Arruda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mauricio Arruda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arruda, M., Natale, A. Ablation of permanent AF. J Interv Card Electrophysiol 23, 51–57 (2008). https://doi.org/10.1007/s10840-008-9252-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-008-9252-z

Keywords

Search

Navigation