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Persistent atrial fibrillation ablation: glimpsing the light ahead?
Xiaofeng Hu1, Luigi Di Biase2, Xumin Hou1
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, No.241 West Huaihai Road, Xuhui District, Shanghai 200030, China.
Summary
Persistent atrial fibrillation (AF) ablation success is limited. This review explores current limitations and proposes novel strategies, including advanced mapping and pulsed field ablation (PFA), to improve outcomes for AF patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Current ablation strategies for persistent atrial fibrillation (AF) achieve suboptimal success rates, approximately 50%.
- Pulmonary vein isolation (PVI) is standard, but adjunctive therapies show inconsistent efficacy.
- Barriers include poor understanding of AF mechanisms, patient variability, lesion durability issues, and lack of standardized endpoints.
Purpose of the Study:
- To critically review current persistent AF ablation outcomes and limitations.
- To identify key challenges hindering successful AF ablation.
- To propose an optimized ablation protocol and discuss emerging technologies.
Main Methods:
- Comprehensive review of existing literature on persistent AF ablation strategies.
- Analysis of randomized controlled trials evaluating adjunctive ablation techniques.
- Examination of novel electro-anatomically guided protocols and advanced mapping techniques.
- Discussion of emerging technologies like pulsed field ablation (PFA).
Main Results:
- Current ablation strategies, including PVI, have limited success rates in persistent AF.
- Inconsistent results from adjunctive strategies highlight the need for improved approaches.
- Key limitations identified include mechanistic understanding, patient heterogeneity, technical challenges, and procedural endpoint standardization.
Conclusions:
- Optimizing persistent AF ablation requires addressing current limitations and exploring novel strategies.
- A proposed electro-anatomically guided protocol with advanced mapping and defined endpoints may improve AF termination.
- Emerging technologies like PFA offer potential for enhanced safety and long-term efficacy in AF management.
