title: Pulmonary vein triggers, focal sources, rotors and atrial cardiomyopathy: implications for the choice of the most effective ablation therapy.
abstract: Understanding of the pathophysiological mechanism(s) underlying atrial fibrillation (AF) is the foundation on which current ablation strategies are built. In the vast majority of patients with paroxysmal AF, the ablation procedure should target the pulmonary veins. In patients with nonparoxysmal AF, however, pulmonary vein isolation alone seems to be insufficient to prevent the arrhythmia. Several recent clinical trials have investigated the concept that rotors (re-entry based on a meandering central core from which spiral waves emanate) might be the mechanism responsible for sustaining AF. Ablation of these localized AF sources is an important step towards substrate-driven procedures in persistent AF. Hybrid AF ablation procedures, based on the integration of endocardial transcatheter and epicardial off-pump surgical techniques, have been introduced to overcome their mutual shortcomings. The long-term results are encouraging, especially in currently challenging settings such as nonparoxysmal AF and failed endocardial catheter ablation procedures.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Pison
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Tilz
authors.affiliation: Center for Arrhythmia Research, Department of Internal Medicine/Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: J
authors.initials: J
authors.lastname: Jalife
authors.affiliation: LIRYC Institute (Electrophysiology and Heart Modeling Institute), Hôpital Cardiologique du Haut Lévêque and Université Victor Segalen of Bordeaux II, Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D057791:Cardiac Imaging Techniques; D009202:Cardiomyopathies / Q000209:etiology; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D011667:Pulmonary Veins / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods
keywords: ablation; atrial fibrillation; atrial remodelling; body surface mapping; mechanism; video-assisted thoracoscopic surgery