Catheter ablation of atrial fibrillation
Authors:
R. Lábrová; J. Špinar
Authors‘ workplace:
Interní kardiologická klinika LF MU a FN Brno
Published in:
Kardiol Rev Int Med 2008, 10(3): 103-110
Overview
Atrial fibrillation is the most frequent disorder of heart rhythm with constantly increasing incidence and prevalence. Although pharmacotherapy remains the primary method of choice to treat the fibrillation it slowly becomes ineffective and may produce side effects and adverse events. The selective catheter ablation interferes with the pathophysiological mechanism of onset and preservation of atrial fibrillation and as a result it restitutes sinus rhythm. In paroxysmal atrial fibrillation we usually electrically isolate active ectopic foci in pulmonary veins antrums. In persistent or permanent form of atrial fibrillation we perform a more complex ablation because in these cases electrical and functional atrial remodelation has already developed. Besides performing wider circle leasions around the pulmonary veins antrums we proceed with another linear leasions in the left atrium, sometimes in the right atrium and coronary sinus, respectively. Such leasions affect reentry circles in atrial wall that help the fibrillation preserve. The catheter ablation of paroxysmal atrial fibrillation has become a routine treatment modality in symptomatic patients resistent to antiarrhytmic drugs. Also increasing amount of patients with an organic heart disease with or without heart failure are being indicated to the catheter ablation. The restitution of sinus rhythm may improve or fully normalize the systolic function of the left ventricle. To make catheter ablations less time-consuming and less technically difficult new sophisticated techniques are being explored.
Key words:
atrial fibrillation – paroxysmal – persistent – permanent – radiofrequency catheter ablation – electrical isolation of pulmonary veins – combination techniques
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