Predictors of Recurrence After Radiofrequency Ablation of Persistent Atrial Fibrillation

Abstract

Radiofrequency catheter ablation that targets the pulmonary veins is well established as a mainstay for drug-refractory, paroxysmal atrial fibrillation (AF). However, in patients with persistent AF, the ideal approach remains elusive. Further, despite the various additional ablation strategies that have been investigated in patients with persistent AF, the rate of recurrent atrial tachyarrhythmias after ablation remains relatively high. In this review, the predictors of recurrent atrial tachyarrhythmias after catheter ablation of persistent AF will be discussed.

Figure 1.. Additional ablation of complex fractionated atrial electrograms at the base of the right atrial appendage (A) resulted in termination of atrial fibrillation (AF) to sinus rhythm during ablation in a patient with long-standing persistent AF (B). ABL= ablation catheter; CS= coronary sinus; IVC= inferior vena cava; LA= left atrium; RA= right atrium; SVC= superior vena cava

Figure 2.. Activation map during peri-mitral reentry (A: left anterior oblique projection). Entrainment mapping from the lateral mitral annulus demonstrates that the post-pacing interval is 245 ms, matching the tachycardia cycle length (B). Endocardial ablation at the mitral isthmus failed to terminate the tachycardia. Radiofrequency energy delivery in the distal coronary sinus (CS) terminated the tachycardia to sinus rhythm. (C). ABL= ablation catheter; MA= mitral annulus