title: Current hot potatoes in atrial fibrillation ablation.
abstract: Atrial fibrillation (AF) ablation has evolved to the treatment of choice for patients with drug-resistant and symptomatic AF. Pulmonary vein isolation at the ostial or antral level usually is sufficient for treatment of true paroxysmal AF. For persistent AF ablation, drivers and perpetuators outside of the pulmonary veins are responsible for AF maintenance and have to be targeted to achieve satisfying arrhythmia-free success rate. Both complex fractionated atrial electrogram (CFAE) ablation and linear ablation are added to pulmonary vein isolation for persistent AF ablation. Nevertheless, ablation failure and necessity of repeat ablations are still frequent, especially after persistent AF ablation. Pulmonary vein reconduction is the main reason for arrhythmia recurrence after paroxysmal and to a lesser extent after persistent AF ablation. Failure of persistent AF ablation mostly is a consequence of inadequate trigger ablation, substrate modification or incompletely ablated or reconducting linear lesions. In this review we will discuss these points responsible for AF recurrence after ablation and review current possibilities on how to overcome these limitations.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France. laurent.roten@insel.ch
authors.forename: Laurent
authors.initials: L
authors.lastname: Roten
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pascale
authors.forename: Daniel
authors.initials: D
authors.lastname: Scherr
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
authors.forename: Khaled
authors.initials: K
authors.lastname: Ramoul
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001281:Atrial Fibrillation / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D006801:Humans; D008280:Magnetics; D011667:Pulmonary Veins / Q000601:surgery*; D012371:Robotics / Q000379:methods