title: Atrial fibrillation ablation.
abstract: Radiofrequency catheter ablation is currently used widely and successfully to treat a variety of arrhythmias, and ablation for atrial fibrillation represents the frontier of arrhythmia research. Development in many areas will offer to the electrophysiologic community a more rational and effective background upon which select patients for ablation and identify the optimal ablative strategy. Among mechanisms recognized for having a role in atrial fibrillation stay pulmonary vein focal triggers, rotor at the pulmonary vein-left atrial junction, a critical mass to sustain fibrillatory conduction and vagal ganglia. The latter represents the frontier of research as with new technologies based on magnetic resonance imaging they could be easily and specifically identified and targeted for ablation. It is fundamental that both CARTO and NavX systems are currently investigating integration with magnetic resonance imaging to reconstruct the left atrium. Furthermore a learning curve effect can be abated with the use of new systems for the remote control of the catheter such as stereotaxis. In the last decade, we empirically devised a technique that is both safe and effective for curing atrial fibrillation. Briefly, using a three-dimensional mapping system, either CARTO or NavX system, we reconstruct the left atrium and the pulmonary ostia; thereafter circumferential ablation lines are normally created starting at the lateral mitral annulus and withdrawing posterior then anterior to the left-sided pulmonary veins, passing between the left superior pulmonary vein and the left atrial appendage before completing the circumferential line on the posterior wall of the left atrium. The right pulmonary veins are isolated in a similar fashion, and then a posterior line connecting the two circumferential lines on the roof is performed to reduce the risk of macroreentrant atrial tachycardias. The endpoint for circumferential ablation is a > 70-90% reduction in voltage within the isolated regions. In this article we sought to describe critical methodological aspects of our techniques along with future implementation with new technologies and to summarize our published clinical experience on the most prestigious journals.
authors.affiliation: Electrophysiology and Cardiac Pacing Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy. carlo.pappone@hsr.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Augello
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation; D006801:Humans; D021621:Imaging, Three-Dimensional; D011667:Pulmonary Veins / Q000294:innervation; D016896:Treatment Outcome