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Non-inducibility or termination as endpoints of atrial fibrillation ablation: What is the role?

Catheter ablation is widely used to treat drug-refractory, symptomatic atrial fibrillation (AF). However, beyond pulmonary vein isolation, there remains little consensus on the recommended approach to ablation both in paroxysmal or persistent AF patients. Although ancillary ablation strategies are often used, the lack of a clear endpoint for AF ablation makes it challenging to evaluating their importance. Non-inducibility of AF and termination of AF during AF ablation have been advocated as potential endpoints. Several studies have attempted to assess their role in an AF ablation protocol.  However, the data for non-inducibility and termination as endpoints are mixed. Moreover, there are a number of limitations in the studies reported and limitations of the endpoints themselves. It is likely that non-inducibility of AF or termination of AF during AF ablation may be markers of less structural remodeling rather than true endpoints for ablation. Herein, we review the relevant literature on the topic of inducibility and termination with respect to AF ablation and attempt to draw conclusions with guidance to further investigation.

Credits: Matthew Baker; Prabhat Kumar; James Hummel; Anil Gehi

Biosense Webster
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Introduction to AFib
Ablation Specialist

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