title: Limited Ablation for Persistent Atrial Fibrillation Using Preprocedure Reverse Remodelling.
abstract: Pulmonary vein isolation (PVI) has been demonstrated to be a highly effective treatment option for patients with paroxysmal atrial fibrillation (AF), but less effective for patients with persistent AF. The lower efficacy of PVI alone has been attributed to adverse atrial electrical and structural remodelling in the setting of AF. Strategies to improve efficacy of catheter ablation for persistent AF alter these pathophysiological characteristics of atrial tissue remodelling. Here we will review the physiology of atrial electrical remodelling observed during AF and evidence that it is reversible. Further, we will explore its uses to reduce the amount of atrial tissue that needs to be ablated to successfully treat patients with persistent AF.
authors.affiliation: Assistant Professor of Cardiology, Hofstra North Shore-LIJ School of Medicine, and Associate Director - Cardiac Electrophysiology Laboratory, Long Island Jewish Medical Center;
authors.forename: David
authors.initials: D
authors.lastname: Slotwiner
authors.affiliation: Adjunct Professor of Medicine, University of Rochester School of Medicine, and Director, Arrhythmia Institute, The Valley Health System, New York and New Jersey, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Steinberg
keywords: Atrial fibrillation; antiarrhythmic drug therapy; catheter ablation; reverse electrical remodelling
references.citation: J Cardiovasc Electrophysiol. 2011 Feb;22(2):142-8
references.pmid: 20812936
references.citation: J Interv Card Electrophysiol. 2006 Sep;16(3):153-67
references.pmid: 17103313
references.citation: Heart. 2005 Feb;91(2):166-70
references.pmid: 15657225
references.citation: Pacing Clin Electrophysiol. 2000 Jul;23 (7):1127-32
references.pmid: 10914369
references.citation: Circ Res. 1997 Oct;81(4):512-25
references.pmid: 9314832
references.citation: Circulation. 1995 Oct 1;92(7):1954-68
references.pmid: 7671380
references.citation: Cardiovasc Res. 1999 Oct;44(1):121-31
references.pmid: 10615396
references.citation: Pacing Clin Electrophysiol. 2006 Oct;29(10):1089-95
references.pmid: 17038141
references.citation: Pacing Clin Electrophysiol. 2007 Apr;30(4):502-9
references.pmid: 17437574
references.citation: Heart Rhythm. 2012 Jul;9(7):1031-2
references.pmid: 22465456
references.citation: J Am Coll Cardiol. 1992 Jun;19(7):1531-5
references.pmid: 1593049
references.citation: Ann Noninvasive Electrocardiol. 2006 Jan;11(1):12-9
references.pmid: 16472277
references.citation: Pacing Clin Electrophysiol. 2000 Jul;23 (7):1109-12
references.pmid: 10914366
references.citation: Cardiol J. 2011;18(6):625-31
references.pmid: 22113749
references.citation: Cardiovasc Res. 1999 May;42(2):470-6
references.pmid: 10533582
references.citation: Cardiovasc Res. 2002 May;54(2):230-46
references.pmid: 12062329
references.citation: Circulation. 1995 Mar 1;91(5):1588-95
references.pmid: 7867201
references.citation: Circ Arrhythm Electrophysiol. 2008 Apr;1(1):62-73
references.pmid: 19808395
references.citation: Am J Cardiol. 2010 Jul 1;106(1):62-8
references.pmid: 20609649
references.citation: Can J Cardiol. 2004 Mar 1;20(3):311-5
references.pmid: 15054511
references.citation: J Cardiovasc Electrophysiol. 2004 May;15(5):507-12
references.pmid: 15149416
references.citation: Pacing Clin Electrophysiol. 2003 Jan;26(1 Pt 2):299-304
references.pmid: 12687833
references.citation: Int J Cardiol. 2006 Oct 10;112(3):308-15
references.pmid: 16309759
references.citation: Europace. 2009 Dec;11(12):1620-3
references.pmid: 19910313
references.citation: Heart Rhythm. 2012 Jul;9(7):1025-30
references.pmid: 22342863