Mechanisms


The means by which these procedures work continue to be speculative. The 2007 Consensus Statement (Calkins 2007) does note two basic strategies for curing AF: those that target the pulmonary veins, and approaches that do not target the pulmonary veins. The Task Force recommended that:

  • Ablation strategies which target the PVs and/or PV antrum are the cornerstone for most AF ablation procedures.
  • If the PVs are targeted, complete electrical isolation should be the goal.
  • Careful identification of the PV ostia is mandatory to avoid ablation within the PVs.
  • If a focal trigger is identified outside a PV at the time of an AF ablation procedure, it should be targeted, if possible.
  • If additional linear lesions are applied, line completeness should be demonstrated by mapping or pacing maneuvers.
  • Ablation of the cavotricuspid isthmus is recommended only in patients with a history of typical atrial flutter or inducible cavotricuspid isthmus dependent atrial flutter.
  • If patients with longstanding persistent AF are approached, ostial PV isolation alone may not be sufficient.

Regarding approaches that do not target the pulmonary veins, they discuss Complex Fractionated Atrial Electrograms (CFAE) and ablation of the Ganglionated Plexi (GP).