Avtor/Urednik		O'Neill, Mark D.; Jaïs, Pierre; Takahashi, Yoshihide; Jönsson, Anders; Sacher, Frédéric; Hocini, Méleze; Sanders, Prashanthan; Rostock, Thomas; Rotter, Martin; Pernat, Andrej; Clémenty, Jacques; Haïssaguerre, Michel
Naslov		The stepwise ablation approach for chronic atrialfibrillation - vidence for a cumulative effect
Tip		članek
Vol. in št.		Letnik 16, št. 3
Leto izdaje		2006
Obseg		str. 153-167
ISSN		1383-875X - Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
Jezik		eng
Abstrakt		Treatment options for atrial fibrillation (AF) have evolved from simple, fluoroscopy-guided pulmonary vein isolation for those patients with paroxysmal AF to complex, multi-modality procedures targeting not only anatomic structures but also electrophysiologic phenomena including complex fractionated electrograms, sites of dominant frequency and local non-venous drivers in patients with persistent and permanent AF. The stepwise ablation approach is a novel technique whereby structures contributing to initiation and maintenance of AF are sequentially targeted by radiofrequency ablation. Broadly divided into pulmonary veins, left atrial (LA) roof, left atrium (incorporating all anatomic regions of the chamber), mitral isthmus and non-LA structures, each region is targeted in sequence and the impact of ablation upon the global fibrillatory process assessed by measurement of AF cycle length (AFCL) at a site remote from the ablation target. In addition to pulmonary vein electrical disconnection and demonstrable complete conduction block across the roof and mitral isthmus lines (when performed), ablation is performed at those sites displaying continuous electrical and complex fractionated activity, with the endpoint of local organization, as well as at sites displaying electrograms consistent with focal sources driving AF. Ablation is accompanied by a cumulative increase in the AFCL prior to termination of AF by conversion either directly to sinus rhythm or to an atrial tachycardia which is then mapped conventionally and ablated. There is a ceiling of ablation within the LA beyond which further ablation is unlikely to result in a clinical benefit and should prompt evaluation of the contribution of the right atrium to maintenance of AF. The stepwise approach benefits from the integration of anatomic and electrophysiologic information to achieve a high level of success in termination of chronic AF by catheter ablation.
Proste vsebinske oznake		atrijska fibrilacija aritmija katetrska ablacija atrial fibrillation arrhythmia catheter ablation