The continuous challenge of AF ablation: From foci to rotational activity
| Autor: | Junaid A.B. Zaman, Tina Baykaner, Paul J. Wang, Mohan N. Vishwanathan, Miguel Rodrigo, Sanjiv M. Narayan, Christopher A.B. Kowalewski |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_treatment 030204 cardiovascular system & hematology Article Pulmonary vein 03 medical and health sciences 0302 clinical medicine Optical mapping Internal medicine Atrial Fibrillation medicine Humans In patient 030212 general & internal medicine Cardiac Surgical Procedures General Environmental Science business.industry Atrial fibrillation Ablation medicine.disease Review article Clinical Practice lcsh:RC666-701 Catheter Ablation Cardiology General Earth and Planetary Sciences Cardiology and Cardiovascular Medicine business Af ablation |
| Zdroj: | Revista Portuguesa de Cardiologia, Vol 36, Iss, Pp 9-17 (2017) Revista Portuguesa de Cardiologia (English Edition), Vol 36, Iss, Pp 9-17 (2017) |
| ISSN: | 0870-2551 |
| Popis: | Pulmonary vein isolation (PVI) is central to ablation approaches for atrial fibrillation (AF), yet many patients still have arrhythmia recurrence after one or more procedures despite the latest technology for PVI. Ablation of rotational or focal sources for AF, which lie outside the pulmonary veins in many patients, is a practical approach that has been shown to improve success by many groups. Localized sources lie in atrial regions shown mechanistically to sustain AF in optical mapping and clinical studies of human AF, as well as computational and animal studies. Because they arise in localized atrial regions, AF sources may explain central paradoxes in clinical practice – such as how limited ablation in patient specific sites can terminate persistent AF yet extensive anatomical ablation at stereotypical locations, which should extinguish disordered waves, does not improve success in clinical trials. Ongoing studies may help to resolve many controversies in the field of rotational sources for AF. Studies now verify rotational activation by multiple mapping approaches in the same patients, at sites where ablation terminates persistent AF. However, these studies also show that certain mapping methods are less effective for detecting AF sources than others. It is also recognized that the success of AF source ablation is technique dependent. This review article provides a mechanistic and clinical rationale to ablate localized sources (rotational and focal), and describes successful techniques for their ablation as well as pitfalls to avoid. We hope that this review will serve as a platform for future improvements in the patient-tailored ablation for complex arrhythmias. Keywords: Atrial fibrillation, Ablation, Rotors, Computer, Mapping |
| Databáze: | OpenAIRE |
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