The Present and Future
State-of-the-Art Review
Atrial Fibrillation Ablation: Translating Basic Mechanistic Insights to the Patient

https://doi.org/10.1016/j.jacc.2014.06.1172Get rights and content
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Abstract

Atrial fibrillation (AF) ablation is widely performed and is progressively supplanting drug therapy. Catheter-based AF ablation modalities have evolved progressively in parallel to our understanding of underlying mechanisms. Initial attempts to mimic the surgical maze procedure, which were based on the multiple wavelet model, failed because of adverse outcomes and insufficient effectiveness. A major advance was the targeting of pulmonary veins, which is highly effective for paroxysmal AF. Active research on the underlying mechanisms continues. The main challenge is reconnection, but procedures to minimize this are being developed. Ablation procedures for persistent AF are presently limited by suboptimal success rates and long-term disease progression that causes recurrences. Basic research into the underlying mechanisms has led to promising driver mechanism-directed clinical approaches along with pathways toward the prevention of atrial remodeling. Here, we review the role of basic research in the development of presently used AF-ablation procedures and look toward future contributions in improving outcomes.

Key Words

atrial fibrillation
ectopic focus
ganglionated plexus
pulmonary vein ablation
re-entry
rotors

Abbreviations and Acronyms

AF
atrial fibrillation
CFAE
complex fractionated atrial electrogram
DF
dominant frequency (of fast-Fourier transformed signals)
ERP
effective refractory period
GP
ganglionated plexus
LA
left atrium/atrial
PV
pulmonary vein
PVI
pulmonary vein isolation

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Funding for this work was provided by the Canadian Institutes of Health Research (grant 6957) and Heart and Stroke Foundation of Canada. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Nishida and Datino contributed equally to this work.