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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
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Updated: Sep 13, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Targeting the Substrate: Mechanism-Based Ablation Strategies for Persistent Atrial Fibrillation.

Gabriela-Elena Marascu1,2, Alexandru Ioan Deaconu1,2, Raluca-Elena Mitran2

  • 1Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Journal of Clinical Medicine
|July 29, 2025
PubMed
Summary

Pulmonary vein isolation (PVI) is key for atrial fibrillation (AF) ablation. For persistent AF, personalized, substrate-based strategies using advanced techniques and AI show promise for better outcomes.

Keywords:
ablationatrial fibrillationpersonalized approachpulmonary vein isolationradiofrequency

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Area of Science:

  • Electrophysiology
  • Cardiovascular Medicine
  • Medical Technology

Background:

  • Pulmonary vein isolation (PVI) is a primary treatment for atrial fibrillation (AF), particularly paroxysmal AF.
  • Persistent AF (PsAF) involves complex mechanisms where PVI alone may be insufficient.
  • Substrate-based ablation strategies are gaining importance for PsAF management.

Purpose of the Study:

  • To review current and emerging strategies for atrial fibrillation ablation.
  • To highlight the role of personalized, substrate-based approaches in persistent AF.
  • To discuss advancements in ablation technologies and mapping techniques.

Main Methods:

  • Review of current literature on PVI and AF ablation.
  • Discussion of different ablation modalities: radiofrequency, cryoablation, and pulsed field ablation.
  • Exploration of advanced mapping techniques and AI/machine learning in ablation.

Main Results:

  • PVI is effective for paroxysmal AF, but PsAF requires more complex strategies.
  • Personalized, substrate-based ablation significantly improves outcomes in PsAF.
  • Emerging technologies like pulsed field ablation and AI offer potential for safer and more precise treatments.

Conclusions:

  • While PVI is foundational, tailored substrate ablation is crucial for persistent AF.
  • Advancements in ablation technology and mapping, including AI, are paving the way for personalized AF management.
  • Future research should focus on optimizing these advanced strategies for long-term efficacy.