title: Ablation for Persistent Atrial Fibrillation-Is There a Role for More Than PVI?
abstract: Persistent atrial fibrillation (AF) is a prevalent condition that can be difficult to treat medically, and an ablation strategy is often sought. Currently, the cornerstone of AF ablation strategies is pulmonary vein isolation (PVI). Unfortunately, the single procedure success rates are limited, particularly when long-term outcomes (>1 year) are considered. As a result, the most recent consensus statement recommends that in patients with persistent AF a more extensive ablation be considered. Many additive procedural approaches to PVI have been investigated. These include electrical compartmentalization of the atria with linear lesions (LLs), ablation of complex fractionated atrial electrograms (CFAEs), ablation of the dominant frequency (DF) signals, and focal impulse and rotor modulation (FIRM) ablation. Each of these approaches has demonstrated degrees of additive success when performed with a PVI in patients with persistent AF. This review provides an in-depth discussion of these techniques, their successes in treating persistent AF, and their shortcomings.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lappe
authors.affiliation: Intermountain Medical Center, Intermountain Heart Center, Heart Rhythm Program, Salt Lake City, UT, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cutler
authors.affiliation: Intermountain Medical Center, Intermountain Heart Center, Heart Rhythm Program, Salt Lake City, UT, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Day
authors.affiliation: Intermountain Medical Center, Intermountain Heart Center, Heart Rhythm Program, Salt Lake City, UT, USA. Jared.Bunch@imail.org.|Department of Medicine, Stanford University, Palo Alto, CA, USA. Jared.Bunch@imail.org.|Intermountain Medical Center, 5169 Cottonwood St Bldg 2, Suite 510, Murray, UT, 84107, USA. Jared.Bunch@imail.org.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
keywords: Arrhythmia; Atrial fibrillation; Pulmonary vein isolation