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Updated: Mar 11, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Scar-based catheter ablation for persistent atrial fibrillation
Pablo B Nery1, Rebecca Thornhill, Girish M Nair
1aDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute bDepartment of Medical Imaging, The Ottawa Hospital cDepartment of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Atrial scar-based catheter ablation shows promise for treating persistent atrial fibrillation, offering a new strategy beyond traditional methods. Further research is needed to confirm its effectiveness and optimal use in patients with this complex arrhythmia.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Persistent atrial fibrillation (AF) presents treatment challenges with current catheter ablation success rates of 45-50%.
- Atrial fibrosis and scar are increasingly recognized as key factors in the pathophysiology of persistent AF.
Purpose of the Study:
- To review the role of atrial scar in persistent AF.
- To discuss scar-based mapping techniques and outcomes.
- To explore noninvasive imaging for atrial substrate assessment.
Main Methods:
- Review of current literature on atrial scar and catheter ablation strategies for persistent AF.
- Discussion of voltage mapping techniques for atrial scar identification.
- Evaluation of studies on scar-based ablation outcomes.
- Exploration of delayed enhancement MRI for atrial substrate assessment.
Main Results:
- Atrial scar-based catheter ablation is an emerging strategy for persistent AF.
- Current data on scar-based ablation show promise but have limitations.
- Noninvasive tools like MRI can aid in assessing the atrial substrate.
Conclusions:
- The optimal catheter ablation strategy for persistent AF is still undetermined.
- A deeper understanding of AF substrate and mechanisms is crucial.
- Scar-based catheter ablation is a promising avenue requiring further investigation.
Purpose Of Review:
Percutaneous catheter ablation can be an effective treatment for paroxysmal atrial fibrillation. However, catheter ablation for the treatment of persistent atrial fibrillation or long-standing persistent atrial fibrillation is associated with success rates of 45-50% at 1 year. To address the challenge of ablating patients with persistent atrial fibrillation, several approaches have been proposed. Atrial scar-based catheter ablation is a promising strategy for ablation of persistent atrial fibrillation.
Recent Findings:
In this review, we outline the role of atrial scar/fibrosis in the pathophysiology of atrial fibrillation and how this encouraged clinical studies assessing the atrial substrate using scar-based mapping. We highlight current approaches to voltage mapping of atrial scar in patients with atrial fibrillation. The characteristics, techniques, and outcomes of recently published studies evaluating scar-based catheter ablation strategies for the treatment of atrial fibrillation are discussed. Finally, we explore the role of noninvasive tools such as delayed enhancement MRI to assess the atrial fibrillation substrate.
Summary:
In summary, the optimal catheter ablation strategy for persistent atrial fibrillation remains unknown. Current data highlight the need for a better understanding of the substrate and mechanisms of arrhythmia maintenance in this population. Atrial scar-based catheter ablation has recently emerged as a promising strategy for ablation of atrial fibrillation. However, the available data have limitations that preclude definitive conclusions regarding the utility of this strategy. Further research is needed to assess the role of scar-based ablation for persistent atrial fibrillation.
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