Why “ Isolation of pulmonary veins ” and “ Arrest of AF ” may turn out to be two different events !

AF is not only the most common cardiac arrhythmia,it is also an extensively researched entity in cardiology literature. We are trying to rein in, this arrhythmia for the past three decades with multiple strategies. Drugs, pacemakers, ICDs devices, surgical cuts, RF catheters, and the latest technique is trying to frostbite the atrial electrical circuits with ICE. ( Karl-Heinz Kuck,N Engl J Med 2016 ) It is believed that up 60% of AF originate from pulmonary veins. What does it mean?  So, when we blindly suggest PV Isolation routinely for all PAF,  there is 40% futility straightaway! Apart from the hugely variable anatomy of the pulmonary veins, there are prohibitive levels of recurrence due to  PV reconnections. Maybe, will find new technical solutions as we are now moving in 2nd or third generation cryo balloons, 4D imaging, contact force sensing, etc. But let us not forget there are other sources of focal electrical activity too   Importance of non-PV ectopic beats initiating  AF(Ref 1,2) Superior vena cava (SVC), left atrial posterior free wall (LPFW), LA appendage crista terminalis (CT), coronary sinus ostium (CSO), Ligament of Marshall Interatrial septum (IAS)  Ablation or no ablation, we need to reflect on two things in the management of AF. 1. AF can be triggered by totally different mechanisms like intermittent hypoxia, adverse electrolytic flux, diffuse atrial interstitial pathology or amyloid, etc. Before calling the appointment desk of the EP...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Atrial fibrillation Uncategorized affirm trial CABANA trial fire and ice study atrial fibrillation pulmonary vein isolation race trial rate vs rhythm control in af RF ablation for af right atrial focus in atrial fibrillation svc focus Source Type: blogs