Pulmonary vein reconnections or substrate in the left atrium: what is the reason for atrial fibrillation recurrences? A dialogue on a pressing clinical situation

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
Clemens Jilek, Waqas Ullah

Abstract

Pulmonary vein isolation (PVI) has long been held as the cornerstone for atrial fibrillation (AF) ablation. There are patients who do not have successful AF ablations though, especially among those with persistent AF. At the same time, the evidence suggests that ablating beyond the pulmonary veins does not improve success rates. Two possibilities for the incomplete success rates from the procedure are discussed: that more attention needs to be paid to PVI, optimizing delivery of durable, transmural lesions; or alternatively, shifting the focus away from just PVI and addressing the left atrial substrate itself. These two approaches are likely complementary though, and high-density mapping may offer us the ability to undertake them more effectively. The conclusion from this dialogue is that AF is a heterogenous disease and key is to recognize this heterogeneity and respond to it, rather than have a standardized, dogmatic approach. Durable PVI is clearly an important determinant of success but concurrently, we would suggest we need to go beyond this where appropriate to maximize success rates. Clearly the challenge is defining which patients this is appropriate for and how best to do this. Consequently, rather than being 'the' cor...Continue Reading

References

Aug 1, 1991·Stroke; a Journal of Cerebral Circulation·P A WolfW B Kannel
Sep 3, 1998·The New England Journal of Medicine·M HaïssaguerreJ Clémenty
Jun 14, 2002·Cardiovascular Research·Sawa KostinJutta Schaper
Jun 14, 2002·Cardiovascular Research·Catherine Rücker-MartinStéphane N Hatem
Mar 26, 2003·Circulation·Akira HamabePeng-Sheng Chen
Apr 30, 2008·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Xin-Hua WangJia-Ning Gu
Mar 9, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Claude S ElayiAndrea Natale
Jul 8, 2010·Circulation·Luigi Di BiaseAndrea Natale
Oct 22, 2011·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Hany DimitriPrashanthan Sanders
Dec 6, 2011·Circulation. Arrhythmia and Electrophysiology·Sanjay DixitEdward P Gerstenfeld
Feb 2, 2012·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Srinivas R DukkipatiVivek Y Reddy
Feb 5, 2013·Journal of Cardiovascular Electrophysiology·Michel HaissaguerreRemi Dubois
Apr 30, 2013·Journal of the American College of Cardiology·Adam S FeinElad Anter
Sep 12, 2013·Journal of Cardiovascular Electrophysiology·Claude S ElayiAndrea Natale
Feb 6, 2014·JAMA : the Journal of the American Medical Association·Nassir F MarroucheJohannes Brachmann
Aug 26, 2014·Circulation. Arrhythmia and Electrophysiology·Sascha RolfChristopher Piorkowski
Dec 3, 2014·Journal of the American College of Cardiology·Rajeev K PathakPrashanthan Sanders
Mar 21, 2015·Circulation. Arrhythmia and Electrophysiology·Elad AnterMark E Josephson
May 7, 2015·The New England Journal of Medicine·Atul VermaUNKNOWN STAR AF II Investigators
May 24, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Elad AnterMark E Josephson
Jul 4, 2015·Journal of the American College of Cardiology·Rajiv MahajanPrashanthan Sanders
Jul 15, 2015·Circulation. Arrhythmia and Electrophysiology·Waqas UllahRichard J Schilling
Oct 27, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Eric BuchKalyanam Shivkumar
Oct 30, 2015·Journal of Cardiovascular Electrophysiology·Hans KottkampDoreen Schreiber
Dec 25, 2015·Journal of the American College of Cardiology·Julia VoglerDaniel Steven
Apr 5, 2016·The New England Journal of Medicine·Karl-Heinz KuckUNKNOWN FIRE AND ICE Investigators
May 14, 2016·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Waqas UllahUNKNOWN UK Multicentre Trials Group**
May 29, 2016·Journal of Cardiovascular Electrophysiology·Takanori YamaguchiNaohiko Takahashi
Jun 13, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Christian SohnsAndreas Metzner
Nov 4, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Paulus KirchhofKatja Zeppenfeld
Oct 6, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Alessandra BuiattiPetra Hoppmann
Feb 17, 2017·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Sébastien KnechtThomas Rostock

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Citations

Nov 30, 2019·Journal of Cardiovascular Electrophysiology·Peter M Kistler, David Chieng
Nov 18, 2020·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Koichi InoueUNKNOWN OCVC Arrhythmia Investigators
Jul 3, 2021·Journal of Clinical Medicine·Willemijn F B van der DoesNatasja M S de Groot

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