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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

How to ablate long-standing persistent atrial fibrillation?

Luigi Di Biase1, Pasquale Santangeli, Andrea Natale

  • 1Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA.

Current Opinion in Cardiology
|December 5, 2012
PubMed

Insights

Treating long-standing persistent (LSP) atrial fibrillation requires targeting non-pulmonary vein triggers, such as those in the coronary sinus or left atrial appendage. Higher radiofrequency power (up to 45W) improves lesion durability for better long-term success.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Long-standing persistent (LSP) atrial fibrillation presents a significant challenge in arrhythmia management.
  • Catheter ablation is effective for paroxysmal atrial fibrillation but less so for LSP atrial fibrillation.
  • Existing ablation approaches for LSP atrial fibrillation yield variable outcomes.

Purpose of the Study:

  • To review a specific institutional approach for catheter ablation of LSP atrial fibrillation.
  • To highlight key strategies for improving long-term success in treating this complex arrhythmia.

Main Methods:

  • Ablation targeting pulmonary vein antrum and posterior wall.
  • Pharmacological provocation with isoproterenol to identify non-pulmonary vein triggers.
  • Application of increased radiofrequency power (30-45W).

Main Results:

  • Ablation of non-pulmonary vein triggers (coronary sinus, septum, left atrial appendage, superior vena cava) is crucial for single-procedure success.
  • Termination of atrial fibrillation during ablation does not predict outcome.
  • Higher radiofrequency power (up to 45W) promotes durable lesion formation.

Conclusions:

  • The described approach offers a strategy for effective catheter ablation in patients with LSP atrial fibrillation.
  • Focusing on non-pulmonary vein triggers and optimizing lesion creation are key to successful treatment.
Abstract

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