Student: Dr. Einstein, aren't these the same questions as last year's final exam?Dr. Einstein: Yes, but this year the answers are different.Over the past two decades, catheter ablation for atrial fibrillation (AF) has come full circle. After the seminal observation that AF may be triggered by a focal source, and that elimination of that source could cure AF, multiple additional ablation strategies have been advocated including ablation of complex electrograms, linear left atrial ablation, focal source/rotor ablation, and ablation targeting low‐voltage regions. All these strategies seek to reduce the recurrence rate of AF following ablation and the proportion of patients, perhaps as high as 50%, requiring repeat ablation. The large, multicenter STAR AF II trial in patients with persistent AF tested two of these additional strategies (complex fractionated atrial ablation and linear ablation) and returned the field to where it began: isolate the pulmonary veins, and isolate them effectively.Correspondingly, over recent years there has been increasing and appropriate focus on procedural techniques to improve the formation of durable, transmural, and contiguous atrial radiofrequency (RF) ablation lesions, as well as assessment techniques to quantify such lesions. Although future catheter technologies may enable real‐time visualization of ablation lesions, this is not
Journal of Cardiovascular Electrophysiology – Wiley
Published: Jan 1, 2018
Keywords: ; ;
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