Contemporary approaches to persistent atrial fibrillation

Abstract

Atrial fibrillation (AF) is currently the most commonly treated cardiac arrhythmia. It is generally a progressive disease, often more difficult to control as electromechanical remodeling alters the underlying substrate. Patients typically evolve from infrequent, self-terminating episodes, to more frequent and sustained events. In addition, atrial remodeling may make sinus rhythm more challenging to achieve. Although an ablation strategy limited to pulmonary vein isolation may be curative in those with paroxysmal AF, a more extensive approach is often required in those with persistent AF. This article discusses the current approaches and most recent advances in the ablation of persistent and long-standing persistent AF.

Keywords::

• catheter ablation
• complex fractionated atrial electrogram
• persistent atrial fibrillation
• pulmonary vein isolation

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

^†If patients have both paroxysmal and persistent AF, the AF type should be defined as the most frequent type of AF experienced within 6 months of an ablation.

^‡The term permanent AF is not appropriate in the context of patients undergoing catheter or surgical ablation. If a patient previously classified as having permanent AF is to undergo catheter or surgical ablation, the AF should be reclassified.

AF: Atrial fibrillation; AV: Atrioventricular.

Adapted from the 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation [6].