Toward a Uniform Ablation Protocol for Paroxysmal, Persistent, and Permanent Atrial Fibrillation

Domenico Giovanni Della Rocca; Carlo Lavalle; Carola Gianni; Marco Valerio Mariani; Sanghamitra Mohanty; Chintan Trivedi; Ugur Canpolat; Bryan MacDonald; Huseyin Ayhan; Agostino Piro; Mohamed Bassiouny; Amin Al-Ahmad; John David Burkhardt; Joseph G Gallinghouse; Rodney P Horton; Javier Sanchez; Nicola Tarantino; Luigi Di Biase; Andrea Natale

doi:10.1016/j.ccep.2019.08.014

Toward a Uniform Ablation Protocol for Paroxysmal, Persistent, and Permanent Atrial Fibrillation

Card Electrophysiol Clin. 2019 Dec;11(4):731-738. doi: 10.1016/j.ccep.2019.08.014.

Authors

Domenico Giovanni Della Rocca¹, Carlo Lavalle², Carola Gianni³, Marco Valerio Mariani², Sanghamitra Mohanty³, Chintan Trivedi³, Ugur Canpolat⁴, Bryan MacDonald³, Huseyin Ayhan⁵, Agostino Piro², Mohamed Bassiouny³, Amin Al-Ahmad³, John David Burkhardt³, Joseph G Gallinghouse³, Rodney P Horton³, Javier Sanchez³, Nicola Tarantino⁶, Luigi Di Biase⁷, Andrea Natale⁸

Affiliations

¹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA. Electronic address: domenicodellarocca@hotmail.it.
² Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy.
³ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
⁴ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Sihhiye, Ankara 06532, Turkey.
⁵ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Cardiology, Ankara Yildirim Beyazit, Ankara, Turkey.
⁶ Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
⁷ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA; Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA; Department of Clinical and Experimental Medicine, University of Foggia, Via A. Gramsci, Foggia, Italy.
⁸ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, 107 West Dean Keeton Street, Austin, TX 78712, USA; Interventional Electrophysiology, Scripps Clinic, 9898 Genesee Avenue, La Jolla, CA 92037, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Division of Cardiology, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA.

PMID: 31706479
DOI: 10.1016/j.ccep.2019.08.014

Abstract

Atrial fibrillation catheter ablation has emerged as the most effective strategy to restore and maintain sinus rhythm. The cornerstone of atrial fibrillation ablation is elimination of triggers from the pulmonary veins by pulmonary vein isolation. Nevertheless, some patients may experience atrial tachyarrhythmia recurrences even with permanent pulmonary vein antral isolation. Whether and in which patients pulmonary vein antral isolation should be considered as the only ablation strategy remains a matter of debate. This review aims to summarize the rationale and effectiveness of different ablation approaches and identify key points for a uniform atrial fibrillation ablation strategy.

Keywords: Anticoagulation; Atrial fibrillation; Catheter ablation; Outcome; Stroke; Substrate; Trigger.

Publication types

Review

MeSH terms

Atrial Fibrillation / surgery*
Catheter Ablation*
Humans
Practice Guidelines as Topic