Catheter Ablation of Atrial Arrhythmias: State of the Art

Perspective:

The following are 10 points to remember from this review of catheter ablation (CA) of atrial tachyarrhythmias:

1. CA is considered first-line therapy in patients with symptomatic focal atrial tachycardia (FAT), incessant FAT, or a FAT-induced cardiomyopathy.

2. The most common site of origin of FAT is the crista terminalis.

3. The acute success rate of CA of FAT is 85-90%, and complications are rare.

4. CA is considered first-line therapy for patients with typical atrial flutter (AFl) and for typical AFl that emerges during antiarrhythmic drug therapy for atrial fibrillation (AF).

5. The acute success rate of CA along the cavotricuspid isthmus for typical AFl is >95%, with a 5-10% incidence of recurrence during 2 years of follow-up.

6. Atypical AFl most commonly occurs after atrial surgery or CA of AF, and the success rate of CA is approximately 85%.

7. CA of AF generally is recommended for symptomatic patients who do not respond adequately to antiarrhythmic drug therapy.

8. The principal CA strategy for paroxysmal AF is pulmonary vein isolation, which results in a success rate of 80-90% after redo procedures for recurrence of pulmonary vein conduction in 30-70% of patients.

9. Because the mechanisms of persistent AF are not well-defined in humans, there is not a uniform ablation strategy for this type of AF, and the success rate of CA typically has been <50% after the first procedure and 65% after redo procedures.

10. A recent advance in CA of persistent AF has been the identification of localized sources of AF (focal impulses and/or atrial rotors) by computed signal analysis and the ability to terminate persistent AF by CA of the localized sources.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Incidence, Heart Atria, Follow-Up Studies, Cardiomyopathies, Pulmonary Veins, Catheter Ablation, Tachycardia


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