European Heart Journal Advance Access originally published online on January 6, 2005
European Heart Journal 2005 26(7):627-630; doi:10.1093/eurheartj/ehi005
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Towards more effective techniques for catheter ablation of atrial fibrillation: to aim for electrical disconnection of pulmonary veins or not?
Arrhythmia and Electrophysiology Center, Policlinico San Donato, University of Milan, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
* Tel: +39 02 5277 4337; fax: +39 02 5560 3125. E-mail address: rcappato@libero.it
This editorial refers to ‘Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins’
by M. Hocini et al., on page 696
| The first 150 words of the full text of this article appear below. |
The recent discovery of a dominant role played by excitable tissues within the pulmonary veins (PVs) and at the left atrium–PV junction in the initiation and possibly also the maintenance of atrial fibrillation (AF) has led investigators to develop several catheter-based strategies aimed at limiting the electrophysiological interactions between these areas and the remaining atria. Among these, two have emerged as dominant strategies in current clinical practice: one aiming at ostial segmental disconnection (OSD) of all PVs from the adjacent atrial tissue and another aiming at anatomical circumferential ablation (ACA) away from the orifice of the PVs.
OSD versus ACA
OSD is best accomplished with the help of a pre-shaped circumferential multi-electrode mapping catheter advanced to the orifice of the target PV while an ablation catheter is used for radiofrequency (RF) pulse delivery at the orifice of the same PV. Using this approach, RF pulses are delivered under the guidance of the circumferential
Efficacy of the two strategies
Is either of the two ablation strategies superior to the other?
How to compare the two ablation strategies
Is complete electrical isolation within areas surrounded by ablation lines required for a better outcome?
Towards a unified strategy?
Conclusions
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Related articles in EHJ:
- Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins
- Mélèze Hocini, Prashanthan Sanders, Pierre Jaïs, Li-Fern Hsu, Rukshen Weerasoriya, Christophe Scavée, Yoshihide Takahashi, Martin Rotter, Florence Raybaud, Laurent Macle, Jacques Clémenty, and Michel Haïssaguerre
EHJ 2005 26: 696-704.[Abstract] [FREE Full Text]
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  P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation' Europace, July 1, 2009; 11(7): 860 - 885. [Full Text] [PDF]
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 R. Cappato Towards a unified strategy for atrial fibrillation ablation?: reply Eur. Heart J., August 2, 2005; 26(16): 1688 - 1688. [Full Text] [PDF]
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C. Pappone and V. Santinelli Towards a unified strategy for atrial fibrillation ablation? Eur. Heart J., August 2, 2005; 26(16): 1687 - 1688. [Full Text] [PDF]
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