2^nd World Heart Rhythm Conference

Atrial fibrillation (AF) is the most common sustained arrhythmia. Recent guidelines recommend pulmonary vein isolation (PVI) as the main procedural endpoint to control recurrent AF in symptomatic patients resistant to antiarrhythmic drugs. The efficacy of such a procedure is still unsatisfactory in persistent AF. Thus, the search is on-going in trying to find adjunctive strategies that can fortify the durability of ablation success in AF patients. This review summarizes the benefits of AF ablation techniques, discusses the evidence underlying different approaches other than PVI including: linear ablation, ablation of complex fractionated atrial electro grams (CFAE), focal impulse and rotor modulation (FIRM), ablation guided by spatiotemporal electro gram dispersion, repetitive activation patterns (RAPs) and other sites frequently involved in AF triggers. It is interesting that other independent randomized studies (for example SMAN-AF and STAR AF II trails) have failed to reproduce the same successful results. The reason for the lack of benefit associated with additional ablation in these trials is unclear. A possible explanation is that more extensive ablation may cause new, iatrogenic areas of arrhythmogenesis. It is noted that the low success rate occurred even though the rate of acute procedural AF termination during CFAE ablation was high.

Conclusion: Future studies need to focus on new ablation strategies to achieve better results.