Elimination of triggers has become the hallmark
of catheter ablation of atrial fibrillation (AF). In particular, much attention has been paid
to the elimination of triggering impulses from the pulmonary veins via
pulmonary vein ablation procedures. While this approach has a proven track record for paroxysmal AF, the
efficacy in non-paroxysmal AF has been less convincing. Thus, attention has been paid to elimination
of the substrate responsible for AF perpetuation, including complex
fractionated electrograms, dominant frequency sites, and autonomic ganglionated
plexi. None of these targets has yet
become mainstream, but they are all under active investigation. As our knowledge of these targets increases
and clinical studies are performed, a more refined approach to AF ablation will
surely emerge.
Credits: Atul Verma, MD, FRCPC