Ablation has become a cornerstone of therapy for atrial fibrillation
(AF), the most common arrhythmia in the Western world and an important cause of
morbidity and mortality [1]. However, optimal approach for ablation remains hotly debated, and
this is particularly true for the selection of procedural endpoints. Since seminal studies by HaIssaguerre et al [2]
showed that ectopy from the pulmonary veins (PVs) may trigger paroxysms of AF, PV isolation has become central to most
ablation approaches. However, PV isolation often fails to terminate AF, particularly in
patients with persistent AF [3], indicating AF sustaining mechanisms that lie outside the PVs. For this reason or to eliminate additional triggers, many approaches to ablate extra-PV
tissue have been devised whose AF termination rates range from 58% [4] to 87% [5]. However, some constants remain. First, the
event of AF termination is currently extremely difficult if not impossible to predict a priori. Second, AF termination by current ablative approaches is typically to atrial tachycardia, rather than to the sinus
rhythm from which AF usually initiates. Finally, third, despite the intuitive advantages
of AF termination, is remains disputed whether AF termination by current approaches is a
desirable endpoint that improves long-term outcome. This brief review focuses on these
facets of intra-procedural AF termination.
Credits: Tina Baykaner, MD; David E Krummen, MD; Sanjiv M. Narayan, MD PhD