The continuous challenge of AF ablation: From foci to rotational activity
Pulmonary vein isolation (PVI) is central to ablation approaches for atrial fibrillation (AF), yet many patients still have arrhythmia recurrence after one or more procedures despite the latest technology for PVI. Ablation of rotational or focal sources for AF, which lie outside the pulmonary veins...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2017-11-01
|
Series: | Revista Portuguesa de Cardiologia (English Edition) |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2174204917303604 |
id |
doaj-9c30800d54e644c08166e7df07b3dbf4 |
---|---|
record_format |
Article |
spelling |
doaj-9c30800d54e644c08166e7df07b3dbf42020-11-25T02:55:51ZengElsevierRevista Portuguesa de Cardiologia (English Edition)2174-20492017-11-0136917The continuous challenge of AF ablation: From foci to rotational activitySanjiv M. Narayan0Mohan N. Vishwanathan1Christopher A.B. Kowalewski2Tina Baykaner3Miguel Rodrigo4Junaid A.B. Zaman5Paul J. Wang6Corresponding author.; Stanford University, Palo Alto, CA, United StatesStanford University, Palo Alto, CA, United StatesStanford University, Palo Alto, CA, United StatesStanford University, Palo Alto, CA, United StatesStanford University, Palo Alto, CA, United StatesStanford University, Palo Alto, CA, United StatesStanford University, Palo Alto, CA, United StatesPulmonary vein isolation (PVI) is central to ablation approaches for atrial fibrillation (AF), yet many patients still have arrhythmia recurrence after one or more procedures despite the latest technology for PVI. Ablation of rotational or focal sources for AF, which lie outside the pulmonary veins in many patients, is a practical approach that has been shown to improve success by many groups. Localized sources lie in atrial regions shown mechanistically to sustain AF in optical mapping and clinical studies of human AF, as well as computational and animal studies. Because they arise in localized atrial regions, AF sources may explain central paradoxes in clinical practice – such as how limited ablation in patient specific sites can terminate persistent AF yet extensive anatomical ablation at stereotypical locations, which should extinguish disordered waves, does not improve success in clinical trials. Ongoing studies may help to resolve many controversies in the field of rotational sources for AF. Studies now verify rotational activation by multiple mapping approaches in the same patients, at sites where ablation terminates persistent AF. However, these studies also show that certain mapping methods are less effective for detecting AF sources than others. It is also recognized that the success of AF source ablation is technique dependent. This review article provides a mechanistic and clinical rationale to ablate localized sources (rotational and focal), and describes successful techniques for their ablation as well as pitfalls to avoid. We hope that this review will serve as a platform for future improvements in the patient-tailored ablation for complex arrhythmias. Keywords: Atrial fibrillation, Ablation, Rotors, Computer, Mappinghttp://www.sciencedirect.com/science/article/pii/S2174204917303604 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sanjiv M. Narayan Mohan N. Vishwanathan Christopher A.B. Kowalewski Tina Baykaner Miguel Rodrigo Junaid A.B. Zaman Paul J. Wang |
spellingShingle |
Sanjiv M. Narayan Mohan N. Vishwanathan Christopher A.B. Kowalewski Tina Baykaner Miguel Rodrigo Junaid A.B. Zaman Paul J. Wang The continuous challenge of AF ablation: From foci to rotational activity Revista Portuguesa de Cardiologia (English Edition) |
author_facet |
Sanjiv M. Narayan Mohan N. Vishwanathan Christopher A.B. Kowalewski Tina Baykaner Miguel Rodrigo Junaid A.B. Zaman Paul J. Wang |
author_sort |
Sanjiv M. Narayan |
title |
The continuous challenge of AF ablation: From foci to rotational activity |
title_short |
The continuous challenge of AF ablation: From foci to rotational activity |
title_full |
The continuous challenge of AF ablation: From foci to rotational activity |
title_fullStr |
The continuous challenge of AF ablation: From foci to rotational activity |
title_full_unstemmed |
The continuous challenge of AF ablation: From foci to rotational activity |
title_sort |
continuous challenge of af ablation: from foci to rotational activity |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia (English Edition) |
issn |
2174-2049 |
publishDate |
2017-11-01 |
description |
Pulmonary vein isolation (PVI) is central to ablation approaches for atrial fibrillation (AF), yet many patients still have arrhythmia recurrence after one or more procedures despite the latest technology for PVI. Ablation of rotational or focal sources for AF, which lie outside the pulmonary veins in many patients, is a practical approach that has been shown to improve success by many groups. Localized sources lie in atrial regions shown mechanistically to sustain AF in optical mapping and clinical studies of human AF, as well as computational and animal studies. Because they arise in localized atrial regions, AF sources may explain central paradoxes in clinical practice – such as how limited ablation in patient specific sites can terminate persistent AF yet extensive anatomical ablation at stereotypical locations, which should extinguish disordered waves, does not improve success in clinical trials. Ongoing studies may help to resolve many controversies in the field of rotational sources for AF. Studies now verify rotational activation by multiple mapping approaches in the same patients, at sites where ablation terminates persistent AF. However, these studies also show that certain mapping methods are less effective for detecting AF sources than others. It is also recognized that the success of AF source ablation is technique dependent. This review article provides a mechanistic and clinical rationale to ablate localized sources (rotational and focal), and describes successful techniques for their ablation as well as pitfalls to avoid. We hope that this review will serve as a platform for future improvements in the patient-tailored ablation for complex arrhythmias. Keywords: Atrial fibrillation, Ablation, Rotors, Computer, Mapping |
url |
http://www.sciencedirect.com/science/article/pii/S2174204917303604 |
work_keys_str_mv |
AT sanjivmnarayan thecontinuouschallengeofafablationfromfocitorotationalactivity AT mohannvishwanathan thecontinuouschallengeofafablationfromfocitorotationalactivity AT christopherabkowalewski thecontinuouschallengeofafablationfromfocitorotationalactivity AT tinabaykaner thecontinuouschallengeofafablationfromfocitorotationalactivity AT miguelrodrigo thecontinuouschallengeofafablationfromfocitorotationalactivity AT junaidabzaman thecontinuouschallengeofafablationfromfocitorotationalactivity AT pauljwang thecontinuouschallengeofafablationfromfocitorotationalactivity AT sanjivmnarayan continuouschallengeofafablationfromfocitorotationalactivity AT mohannvishwanathan continuouschallengeofafablationfromfocitorotationalactivity AT christopherabkowalewski continuouschallengeofafablationfromfocitorotationalactivity AT tinabaykaner continuouschallengeofafablationfromfocitorotationalactivity AT miguelrodrigo continuouschallengeofafablationfromfocitorotationalactivity AT junaidabzaman continuouschallengeofafablationfromfocitorotationalactivity AT pauljwang continuouschallengeofafablationfromfocitorotationalactivity |
_version_ |
1724715762676924416 |