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Our approach to persistent atrial fibrillation in the setting of pulmonary vein isolation
Author(s) -
Richardson Travis,
Michaud Gregory F.
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14204
Subject(s) - medicine , atrial fibrillation , pulmonary vein , coronary sinus , cardiology , ablation , population , isolation (microbiology) , catheter ablation , environmental health , microbiology and biotechnology , biology
Abstract In patients with persistent atrial fibrillation (AF) despite durable pulmonary vein isolation, there are a variety of approaches to further ablation. Here we summarize our strategy in this population. In brief, our approach is to isolate the posterior wall, ablate the coronary sinus musculature and left lateral ridge, complete a lateral mitral line, and achieve cavotricuspid isthmus block. Subsequently, we target organized atrial flutters and if AF persists, we ablate areas of long, fractionated electrograms within scarred regions. We administer isuprel in patients with a presentation consistent with triggered atrial fibrillation (low scar burden, paroxysms of AF).