The success rate of pulmonary vein antral isolation (PVAI) for paroxysmal atrial fibrillation (AF) has not been realized for persistent or long-standing AF, collectively termed non-paroxysmal AF. Many investigators have described adjunctive ablation strategies to improve outcomes for catheter ablation in patients with non-paroxysmal AF. In this focused review we aim to describe these therapies and current evidence pertaining to their utilization. At present, left atrial posterior wall (LAPW) ablation, non-pulmonary vein (non-PV) trigger ablation and rotor ablation appear to improve outcomes for patients with non-paroxysmal AF when performed in conjunction with PVAI. Randomized controlled trials are necessary to further elucidate such claims.
Credits: Joshua A. Cohen; Moussa Mansour