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Atrial fibrillation (AF) is the most frequently encountered sustained cardiac arrhythmia that is associated with reduced quality of life (QOL) and increased risks of heart failure, cognitive impairment, stroke and death. Contemporary management of AF should primarily include optimal rhythm control strategy and stroke prevention in order to improve AF-related health outcome measures and patient satisfaction. In addition, modification of risk factors is important to consolidate treatment effects. Rate control with medication or ‘ablate and pace’ strategy should be reserved for patients with symptomatic AF in whom rhythm control is not a viable option.1 The major impact of AF on cardiovascular morbidity and mortality has driven the cardiac electrophysiology community to improve strategies to deliver therapies that are safe, effective and patient centred to timely restore and maintain sinus rhythm. Currently, the therapeutic armamentarium for rhythm control in patients with symptomatic AF includes anti-arrhythmic medication and catheter ablation. Catheter ablation has been shown to be superior to anti-arrhythmic drug therapy in maintaining sinus rhythm and reducing symptoms in patients with AF.2 3
It is generally accepted that the pathophysiology of AF includes a trigger to initiate AF, a substrate to maintain AF and modulating risk factors, ultimately resulting in progression to more persistent forms of AF. Over the years, AF ablation strategies have targeted elimination of AF triggers or modification of the arrhythmogenic substrate. Durable pulmonary vein (PV) isolation is the cornerstone of catheter ablation in patients with symptomatic paroxysmal AF.1 Despite advances in catheter-based AF ablation technologies, creation of durable lesions for pulmonary vein isolation (PVI) in a safe and effective …
Contributors AE is the sole contributor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; externally peer reviewed.