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Catheter ablation to prevent recurrent atrial fibrillation: Technical considerations

Rod Passman, MD, MSCE
Section Editors
Bradley P Knight, MD, FACC
N A Mark Estes, III, MD
Deputy Editor
Gordon M Saperia, MD, FACC


The primary trigger for most episodes of atrial fibrillation (AF) involves electrical discharges within one or more pulmonary veins. (See "Mechanisms of atrial fibrillation", section on 'Mechanisms of atrial fibrillation: triggers and substrates'.) Thus, a principle goal of any procedure to reduce the frequency of AF is to electrically isolate the pulmonary veins so that these discharges do not activate atrial tissue. Complete isolation of a pulmonary vein is accomplished when there is both entrance and exit block, commonly known as bidirectional block. Entrance block is accomplished when a stimulus delivered in the left atrium does not enter the pulmonary vein. Exit block is present when a spontaneous or paced impulse within the pulmonary vein fails to exit the view into the atrium.

This first portion of this topic will focus on the anatomic and pathophysiologic basis of AF. This information is relevant to how catheter ablation (CA) techniques might reduce the burden of AF, thereby decreasing symptoms and in some cases reducing the likelihood of tachycardia-mediated cardiomyopathy. The remainder of the topic will discuss technical aspects of CA.

The following discussions of CA are found in other topics:

Indications. (See "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications", section on 'Efficacy'.)

The comparison between CA and antiarrhythmic drug therapy for those patients in whom a rhythm control strategy has been chosen. (See "Maintenance of sinus rhythm in atrial fibrillation: Catheter ablation versus antiarrhythmic drug therapy".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 14, 2017.
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