Atrial fibrillation (AF) is the most common human arrhythmia and leads
to increased morbidity and mortality. Because of demographic changes, the
prevalence of AF will increase in the next decades, requiring better primary
prevention strategies and better treatment options. In 1998, Haissaguerre et al. described
triggering foci in the pulmonary veins (PV) as the prevailing
pathophysiological initiator of paroxysmal AF. Since then, multiple studies
have been conducted using the technique of pulmonary vein isolation (PVI) to
eliminate AF. In short term follow-up, success rates of 60-75% in patients with
paroxysmal AF are reached, with significantly worse results in persistent AF of
approximately 50%. Due to arrhythmia recurrence, multiple procedures are
necessary, especially in patients with persistent AF, to achieve these results.
It is supposed that the cause of arrhythmia recurrence is relapse of pulmonary
vein connection in patients with paroxysmal AF, and the insufficient substrate
modification or new substrate development in patients with persistent AF. Future
techniques like contact force control could improve lesion formation leading to
improved PVI and substrate modification.
Credits: Stephanie Fichtner; Gabriele Hessling; Isabel Deisenhofer