Atrial fibrillation (AF) as the most common supraventricular arrhythmia is scarcely amenable to contemporary treatment. Due to the diverse origin and variable clinical course of AF there is a broad spectrum of therapy options. However, optimal AF management has not become a gold standard yet. In general, the recurrence rate of AF is most often clinically unacceptable despite drug, surgical and/or ablation therapy. Substrate-based approach and ongoing ablation of atrial wall in its selected areas including the vicinity of pulmonary veins can be harmful. Applied physical factors do produce total disintegration of cardiomyocites – both intra- and inter-cellular damage which, in turn, leads to functional hypo-/inactivation of atria irrespective of whether the sinus rhythm is restored or not. In fact, iatrogenic phenomenon of ablation-induced atrial incompetence did emerge. Heterogeneity in clinical results reflects the uncertainty regarding the efficacy, risks and benefits of invasive AF therapy. In this regard the overall burden of AF may increase when using current therapy methods. Applicability of destructive techniques is yet to be fully elucidated and discussed. We hypothesize that currently used ablation and/or surgical techniques are potentially harmful since the success rates are likely achieved through violation of atrial myocardium. That is why a new and well-designed therapeutic strategy is needed. Invention of highly selective curative methods producing fibrillatory/electric blockage with concomitant saving of atrial transport function is to be encouraged.
Credits: Dr. Petras Stirbys MD, PhD