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- Title
ABLATING ATRIAL FIBRILLATION: CUSTOMIZING LESION SETS GUIDED BY ROTOR MAPPING.
- Authors
Zaman, Junaid A. B.; Narayan, Sanjiv M.
- Abstract
Ablation occupies an increasing role in the contemporary management of atrial fibrillation (AF), but results are suboptimal, particularly for persistent AF. While an anatomic approach to ablation is a highly efficacious and safe method to isolate pulmonary vein (PV) triggers, recurrence of AF is not always associated with PV reconnection, and there is compelling evidence that non-PV sites sustain AF after it is triggered. Recent developments in wide-area mapping and signal processing now identify rotors in the vast majority of AF patients that sustain AF and whose elimination improves long-term freedom from AF in multicenter studies. Investigators have now demonstrated rotor and focal sources for AF that show many analogous properties between approaches: they lie in spatially reproducible regions temporally over hours to days, and they are amenable to targeted ablation. This review outlines the rationale and technical developments supporting this mechanistic paradigm for human AF, and discusses how rotor mapping may be implemented for individual patient customization of lesion sets. Mechanistic studies are required to explain why rotor elimination (or other ablation approaches) producing long-term elimination of AF may not always terminate AF acutely, how AF correlates with structural changes on magnetic resonance imaging, and how these findings can be integrated clinically with current ablation strategies to improve patient outcomes.
- Subjects
ATRIAL fibrillation treatment; CATHETER ablation; TISSUE wounds; PULMONARY veins; MAGNETIC resonance imaging
- Publication
Methodist DeBakey Cardiovascular Journal, 2015, Vol 11, Issue 2, p76
- ISSN
1947-6094
- Publication type
Article
- DOI
10.14797/mdcj-11-2-76