Anatomical targets and expected outcomes of catheter-based ablation of atrial fibrillation in 2020.
ablation
atrial fibrillation
electroanatomical mapping
extra pulmonary vein ablation
pulmonary vein isolation
radiofrequency energy
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
25
07
2020
revised:
18
11
2020
accepted:
29
11
2020
pubmed:
8
12
2020
medline:
24
12
2021
entrez:
7
12
2020
Statut:
ppublish
Résumé
Anatomical-based approaches, targeting either pulmonary vein isolation (PVI) or additional extra PV regions, represent the most commonly used ablation treatments in symptomatic patients with atrial fibrillation (AF) recurrences despite antiarrhythmic drug therapy. PVI remains the main anatomical target during catheter-based AF ablation, with the aid of new technological advances as contact force monitoring to increase safety and effective radiofrequency (RF) lesions. Nowadays, cryoballoon ablation has also achieved the same level of scientific evidence in patients with paroxysmal AF undergoing PVI. In parallel, electrical isolation of extra PV targets has progressively increased, which is associated with a steady increase in complex cases undergoing ablation. Several atrial regions as the left atrial posterior wall, the vein of Marshall, the left atrial appendage, or the coronary sinus have been described in different series as locations potentially involved in AF initiation and maintenance. Targeting these regions may be challenging using conventional point-by-point RF delivery, which has opened new opportunities for coadjuvant alternatives as balloon ablation or selective ethanol injection. Although more extensive ablation may increase intraprocedural AF termination and freedom from arrhythmias during the follow-up, some of the targets to achieve such outcomes are not exempt of potential severe complications. Here, we review and discuss current anatomical approaches and the main ablation technologies to target atrial regions associated with AF initiation and maintenance.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
341-359Informations de copyright
© 2020 Wiley Periodicals LLC.
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