TY - JOUR
T1 - Update on atrial fibrillation catheter ablation technologies and techniques
AU - Dewire, Jane
AU - Calkins, Hugh
N1 - Funding Information:
The Johns Hopkins Atrial Fibrillation Program is supported by the Dr Francis P. Chiaramonte Private Foundation, the Marvin Weiner Family Foundation, and the Louise or Norbert Grunwald Endowment. The authors thank Bernadette Barcelon for help in acquiring some of the images used in this Review.
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/10
Y1 - 2013/10
N2 - Catheter ablation of atrial fibrillation (AF) has become an important treatment method. Electrical isolation of the pulmonary veins is the cornerstone of most AF ablation procedures, and is defined by an entrance block observed on a circular multipolar electrode catheter. The safety and efficacy of AF ablation is best established in middle-aged patients with paroxysmal AF. Current guidelines recommend AF ablation with a level Ia indication in this group of patients. The long-term efficacy of AF ablation is well established in patients with paroxysmal AF, but less so in patients with longstanding persistent AF. In this population, current guidelines recommend AF ablation with a level IIb indication. The efficacy of catheter ablation in other patient populations, particularly elderly people and those with concomitant conditions, is also poorly defined. AF ablation is reasonably effective and safe at 12 months of follow-up, but recurrence of AF ≥1 year after ablation is not uncommon. Fortunately, the techniques and tools used for AF ablation continue to evolve. These developments include novel ablation catheters designed to increase safety, efficacy, and precision of the procedure, ablation strategies to target both pulmonary vein and nonpulmonary vein AF triggers, and improved imaging and electrical mapping to guide ablation procedures.
AB - Catheter ablation of atrial fibrillation (AF) has become an important treatment method. Electrical isolation of the pulmonary veins is the cornerstone of most AF ablation procedures, and is defined by an entrance block observed on a circular multipolar electrode catheter. The safety and efficacy of AF ablation is best established in middle-aged patients with paroxysmal AF. Current guidelines recommend AF ablation with a level Ia indication in this group of patients. The long-term efficacy of AF ablation is well established in patients with paroxysmal AF, but less so in patients with longstanding persistent AF. In this population, current guidelines recommend AF ablation with a level IIb indication. The efficacy of catheter ablation in other patient populations, particularly elderly people and those with concomitant conditions, is also poorly defined. AF ablation is reasonably effective and safe at 12 months of follow-up, but recurrence of AF ≥1 year after ablation is not uncommon. Fortunately, the techniques and tools used for AF ablation continue to evolve. These developments include novel ablation catheters designed to increase safety, efficacy, and precision of the procedure, ablation strategies to target both pulmonary vein and nonpulmonary vein AF triggers, and improved imaging and electrical mapping to guide ablation procedures.
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U2 - 10.1038/nrcardio.2013.121
DO - 10.1038/nrcardio.2013.121
M3 - Review article
C2 - 23979215
AN - SCOPUS:84884592134
SN - 1759-5002
VL - 10
SP - 599
EP - 612
JO - Nature Reviews Cardiology
JF - Nature Reviews Cardiology
IS - 10
ER -