Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review
In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has b...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Cardiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/9295326 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832548313939836928 |
|---|---|
| author | Zefferino Palamà Martina Nesti Antonio Gianluca Robles Antonio Scarà Silvio Romano Elena Cavarretta Maria Penco Pietro Delise Mariano Rillo Leonardo Calò Luigi Sciarra |
| author_facet | Zefferino Palamà Martina Nesti Antonio Gianluca Robles Antonio Scarà Silvio Romano Elena Cavarretta Maria Penco Pietro Delise Mariano Rillo Leonardo Calò Luigi Sciarra |
| author_sort | Zefferino Palamà |
| collection | DOAJ |
| description | In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel’s triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann’s bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications. |
| format | Article |
| id | doaj-art-1c8c9d786422404a903d3b05b56a605c |
| institution | Kabale University |
| issn | 2090-0597 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cardiology Research and Practice |
| spelling | doaj-art-1c8c9d786422404a903d3b05b56a605c2025-02-03T06:14:20ZengWileyCardiology Research and Practice2090-05972022-01-01202210.1155/2022/9295326Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art ReviewZefferino Palamà0Martina Nesti1Antonio Gianluca Robles2Antonio Scarà3Silvio Romano4Elena Cavarretta5Maria Penco6Pietro Delise7Mariano Rillo8Leonardo Calò9Luigi Sciarra10Electrophysiology UnitCardiovascular and Neurological DepartmentDepartment of LifeCardiology UnitDepartment of LifeDepartment of Medico-Surgical Sciences and BiotechnologiesDepartment of LifeU.O. CardiologiaElectrophysiology UnitCardiology UnitDepartment of LifeIn spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel’s triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann’s bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.http://dx.doi.org/10.1155/2022/9295326 |
| spellingShingle | Zefferino Palamà Martina Nesti Antonio Gianluca Robles Antonio Scarà Silvio Romano Elena Cavarretta Maria Penco Pietro Delise Mariano Rillo Leonardo Calò Luigi Sciarra Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review Cardiology Research and Practice |
| title | Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review |
| title_full | Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review |
| title_fullStr | Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review |
| title_full_unstemmed | Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review |
| title_short | Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review |
| title_sort | tailoring the ablative strategy for atrial fibrillation a state of the art review |
| url | http://dx.doi.org/10.1155/2022/9295326 |
| work_keys_str_mv | AT zefferinopalama tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT martinanesti tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT antoniogianlucarobles tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT antonioscara tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT silvioromano tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT elenacavarretta tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT mariapenco tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT pietrodelise tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT marianorillo tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT leonardocalo tailoringtheablativestrategyforatrialfibrillationastateoftheartreview AT luigisciarra tailoringtheablativestrategyforatrialfibrillationastateoftheartreview |