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

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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

Summary

This summary is machine-generated.

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.

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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.