Long-standing Persistent Atrial Fibrillation Ablation: the Role of the Inter- and Intra-atrial Bundles

Authors

  • Russell Mitchell Cardiovascular Institute – AdventHealth Medical Group – Orlando (FL), USA.
  • Cesar Augusto Bonilla Isaza Cardiovascular Institute – AdventHealth Medical Group – Orlando (FL), USA. https://orcid.org/0000-0002-2142-3438

Keywords:

Persistent atrial fibrillation; Catheter ablation; Bundles

Abstract

Catheter ablation has become the mainstream treatment of atrial fibrillation, but still remains a challenge in those patient with persistent

and long standing persistent atrial fibrillation.

In addition of isolation of the pulmonary veins, any other areas that can trigger or perpetuate atrial fibrillation need to be isolated. Current technologies may allow to effectively deliver permanently lasting lesions, and therefore improve clinical outcomes after ablation. The specialized conduction system including the Bachmann and septopulmonary bundles, are important substrate targets for the management of atrial fibrillation. The anatomical location of these fibers, and the corresponding approach for ablation are described in this case.

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References

Ganesan AN, Shipp NJ, Brooks AG, Kuklik P, Lau DH, Lim HS, et al. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(2):e004549. https://doi.org/10.1161/JAHA.112.004549

Knecht S, Hocini M, Wright M, Lellouche N, O’Neill MD, Matsuo S, et al. Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation. Eur Heart J. 2008;29(19):2359-66 https://doi.org/10.1093/eurheartj/ehn302

Verma A, Jiang C-Y, Betts TR, Chen J, Deisenhofer I, Mantovan R, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812-22. https://doi.org/10.1056/NEJMoa1408288

Waks JW, Josephson ME. Mechanisms of atrial fibrillation – reentry, rotors and reality. Arrhythm Electrophysiol Rev. 2014;3(2):90-100. https://doi.org/10.15420/aer.2014.3.2.90

De Groot NMS, Houben RPM, Smeets JL, Boersma E, Schotten U, Schalij MJ, et al. Electropathological substrate of longstanding persistent atrial fibrillation in patients with structural heart disease: epicardial breakthrough. Circulation. 2010;122(17):1674-82. https://doi.org/10.1161/circulationaha.109.910901

Di Biase L, Burkhardt JD, Mohanty P, Mohanty S, Sanchez JE, Trivedi C, et al. Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial. J Am Coll Cardiol. 2016;68(18):1929-40. https://doi. org/10.1016/j.jacc.2016.07.770

Oral H, Chugh A, Yoshida K, Sarrazin JF, Kuhne M, Crawford T, et al. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after pulmonary vein isolation for long-lasting persistent atrial fibrillation. J Am Coll Cardiol. 2009;53(9):782-9. https://doi.org/10.1016/j.jacc.2008.10.054

Nademanee K, Oketani N. The role of complex fractionated atrial electrograms in atrial fibrillation. J Am Coll Cardiol. 2009;53(9):790-1. https://doi.org/10.1016/j.jacc.2008.11.022

Gharaviri A, Bidar E, Potse M, Zeemering S, Verheule S, Pezzuto S, et al. Epicardial fibrosis explains increased endo–epicardial dissociation and epicardial breakthroughs in human atrial fibrillation. Front Physiol. 11:68. https://doi.org/10.3389/fphys.2020.00068

Groot N, van der Does L, Yaksh A, Lanters E, Teuwen C, Knops P, et al. Direct proof of endo-epicardial asynchrony of the atrial wall during atrial fibrillation in humans. Circ Arrhythm Electrophysiol. 2016;9(5):e003648. https://doi.org/10.1161/CIRCEP.115.003648

Published

2020-05-06

How to Cite

Mitchell, R. ., & Bonilla Isaza, C. A. (2020). Long-standing Persistent Atrial Fibrillation Ablation: the Role of the Inter- and Intra-atrial Bundles. JOURNAL OF CARDIAC ARRHYTHMIAS, 33(2), 73–81. Retrieved from https://jca.org.br/jca/article/view/3368