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Abstract
Atiarrhythmic drugs that are currently in use are not only frequently ineffective at eliminating atrial fibrillation (AF), but also life-threatening in some patients. However, the accumulating clinical experience along with the remarkable advancement in the technology has made the catheter ablation (CA) of AF more effective and safe. The application of circular mapping catheters that can identify pulmonary vein (PV) potentials (PVPs) within the PVs has allowed the effective guidance of the electrical isolation of the PVs from the left atrium (LA). The widespread utilization of 3-dimensional (D) mapping systems has facilitated the improvement of the outcomes after CA in patients with paroxysmal (PAF) and even chronic AF (CAF). Different strategies that are currently in use are as follows segmental ablation of each PV ostium guided by PVPs, pure anatomic approach of circumferential PV ablation (CPVA), CPVA with electrical isolation, complex fractionated atrial electrograms during AF guided ablation, and ablation of ganglionated plexuses, etc. The efficacy of each approach varies according to the investigators and subsets of AF. CPVA with electrical isolation is known to be more effective and is widely used. With further development of new energy sources of ablation and mapping systems, it is important to simplify, standardize, and shorten the procedures, which may enable the CA to become more effective, safe, and applicable to many different subsets of AF. CA of AF has evolved rapidly and has become accepted as one of the therapeutic modalities to cure AF.
Figures and Tables
Figure 1
Pulmonary vein isolation confirmed by elimination of PVPs (*)
PVP: pulmonary vein potential, RSPV: right superior pulmonary vein, LAO: left anterior oblique
Figure 2
Circumferential pulmonary vein ablation with isolation
A) 3-Dimensional Mapping System Guided Circumferential Pulmonary Vein Ablation, B) Elimination of PVPs by Additional Ablation at the LA-PVJunction Showing PVPs
After encircling of pulmonary veins (white circles in panel A), additional radiofrequency energy was delivered at the LA-PV junction (dark circles in panel A) to eliminate PVPs (*) as shown in panel B).
LSPV: left superior pulmonary vein, LIPV: left inferior pulmonary vein, RSPV: right superior pulmonary vein, RIPV: right inferior pulmonary vein, LA-PV: left atrium-pulmonary vein, PVP: pulmonary vein potential
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