How to ablate long-standing persistent atrial fibrillation?

Luigi Di Biase, Pasquale Santangeli, Andrea Natale

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Long-standing persistent (LSP) atrial fibrillation is the most challenging arrhythmia to treat. Catheter ablation of atrial fibrillation has reached satisfactory results for the long-term treatment of paroxysmal atrial fibrillation, but not for the treatment of LSP atrial fibrillation. Several approaches with various outcomes have been described in the literature. The purpose of this review is to summarize the ablation approach that we developed at our institution. RECENT FINDINGS: During ablation of LSP atrial fibrillation, in addition to pulmonary vein antrum and posterior wall isolation, ablation of nonpulmonary vein triggers disclosed by high dosage of isoproterenol seems to be of utmost importance to achieve long-term success after a single procedure. The location of the nonpulmonary vein triggers includes the coronary sinus, the anterior part of the septum, the left atrial appendage and the superior vena cava. Termination of atrial fibrillation during ablation does not seem to influence the outcome. Increasing radiofrequency power from 30 up to 45W seems an important factor to favour durable lesions. SUMMARY: The approach described in this review will guide the reader to what we believe is the best approach for the ablation of patients with LSP atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)26-35
Number of pages10
JournalCurrent Opinion in Cardiology
Volume28
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Atrial Fibrillation
Veins
Atrial Appendage
Superior Vena Cava
Catheter Ablation
Coronary Sinus
Pulmonary Veins
Isoproterenol
Cardiac Arrhythmias
Therapeutics

Keywords

  • catheter ablation
  • long-standing persistent atrial fibrillation
  • outcomes
  • radiofrequency energy
  • technique

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

How to ablate long-standing persistent atrial fibrillation? / Di Biase, Luigi; Santangeli, Pasquale; Natale, Andrea.

In: Current Opinion in Cardiology, Vol. 28, No. 1, 01.2013, p. 26-35.

Research output: Contribution to journalArticle

Di Biase, Luigi ; Santangeli, Pasquale ; Natale, Andrea. / How to ablate long-standing persistent atrial fibrillation?. In: Current Opinion in Cardiology. 2013 ; Vol. 28, No. 1. pp. 26-35.
@article{e5d849abdf8c410d9929a7ef2f1ef95d,
title = "How to ablate long-standing persistent atrial fibrillation?",
abstract = "PURPOSE OF REVIEW: Long-standing persistent (LSP) atrial fibrillation is the most challenging arrhythmia to treat. Catheter ablation of atrial fibrillation has reached satisfactory results for the long-term treatment of paroxysmal atrial fibrillation, but not for the treatment of LSP atrial fibrillation. Several approaches with various outcomes have been described in the literature. The purpose of this review is to summarize the ablation approach that we developed at our institution. RECENT FINDINGS: During ablation of LSP atrial fibrillation, in addition to pulmonary vein antrum and posterior wall isolation, ablation of nonpulmonary vein triggers disclosed by high dosage of isoproterenol seems to be of utmost importance to achieve long-term success after a single procedure. The location of the nonpulmonary vein triggers includes the coronary sinus, the anterior part of the septum, the left atrial appendage and the superior vena cava. Termination of atrial fibrillation during ablation does not seem to influence the outcome. Increasing radiofrequency power from 30 up to 45W seems an important factor to favour durable lesions. SUMMARY: The approach described in this review will guide the reader to what we believe is the best approach for the ablation of patients with LSP atrial fibrillation.",
keywords = "catheter ablation, long-standing persistent atrial fibrillation, outcomes, radiofrequency energy, technique",
author = "{Di Biase}, Luigi and Pasquale Santangeli and Andrea Natale",
year = "2013",
month = "1",
doi = "10.1097/HCO.0b013e32835b59bb",
language = "English (US)",
volume = "28",
pages = "26--35",
journal = "Current Opinion in Cardiology",
issn = "0268-4705",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - How to ablate long-standing persistent atrial fibrillation?

AU - Di Biase, Luigi

AU - Santangeli, Pasquale

AU - Natale, Andrea

PY - 2013/1

Y1 - 2013/1

N2 - PURPOSE OF REVIEW: Long-standing persistent (LSP) atrial fibrillation is the most challenging arrhythmia to treat. Catheter ablation of atrial fibrillation has reached satisfactory results for the long-term treatment of paroxysmal atrial fibrillation, but not for the treatment of LSP atrial fibrillation. Several approaches with various outcomes have been described in the literature. The purpose of this review is to summarize the ablation approach that we developed at our institution. RECENT FINDINGS: During ablation of LSP atrial fibrillation, in addition to pulmonary vein antrum and posterior wall isolation, ablation of nonpulmonary vein triggers disclosed by high dosage of isoproterenol seems to be of utmost importance to achieve long-term success after a single procedure. The location of the nonpulmonary vein triggers includes the coronary sinus, the anterior part of the septum, the left atrial appendage and the superior vena cava. Termination of atrial fibrillation during ablation does not seem to influence the outcome. Increasing radiofrequency power from 30 up to 45W seems an important factor to favour durable lesions. SUMMARY: The approach described in this review will guide the reader to what we believe is the best approach for the ablation of patients with LSP atrial fibrillation.

AB - PURPOSE OF REVIEW: Long-standing persistent (LSP) atrial fibrillation is the most challenging arrhythmia to treat. Catheter ablation of atrial fibrillation has reached satisfactory results for the long-term treatment of paroxysmal atrial fibrillation, but not for the treatment of LSP atrial fibrillation. Several approaches with various outcomes have been described in the literature. The purpose of this review is to summarize the ablation approach that we developed at our institution. RECENT FINDINGS: During ablation of LSP atrial fibrillation, in addition to pulmonary vein antrum and posterior wall isolation, ablation of nonpulmonary vein triggers disclosed by high dosage of isoproterenol seems to be of utmost importance to achieve long-term success after a single procedure. The location of the nonpulmonary vein triggers includes the coronary sinus, the anterior part of the septum, the left atrial appendage and the superior vena cava. Termination of atrial fibrillation during ablation does not seem to influence the outcome. Increasing radiofrequency power from 30 up to 45W seems an important factor to favour durable lesions. SUMMARY: The approach described in this review will guide the reader to what we believe is the best approach for the ablation of patients with LSP atrial fibrillation.

KW - catheter ablation

KW - long-standing persistent atrial fibrillation

KW - outcomes

KW - radiofrequency energy

KW - technique

UR - http://www.scopus.com/inward/record.url?scp=84871638247&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84871638247&partnerID=8YFLogxK

U2 - 10.1097/HCO.0b013e32835b59bb

DO - 10.1097/HCO.0b013e32835b59bb

M3 - Article

C2 - 23207492

AN - SCOPUS:84871638247

VL - 28

SP - 26

EP - 35

JO - Current Opinion in Cardiology

JF - Current Opinion in Cardiology

SN - 0268-4705

IS - 1

ER -