Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation
Atrial fibrillation (AF) often requires invasive treatment by ablation to decrease symptom burden. The pulmonary veins (PV) are thought to trigger paroxysms of AF, and ablative PV isolation (PVI) is a cornerstone in AF treatment. However, incomplete PVI, where electrical conduction between the PV an...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Physiology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphys.2023.1157338/full |
| _version_ | 1797821505906671616 |
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| author | Lisa A. Gottlieb Lisa A. Gottlieb Lisa A. Gottlieb Lukas R. C. Dekker Lukas R. C. Dekker Ruben Coronel Ruben Coronel |
| author_facet | Lisa A. Gottlieb Lisa A. Gottlieb Lisa A. Gottlieb Lukas R. C. Dekker Lukas R. C. Dekker Ruben Coronel Ruben Coronel |
| author_sort | Lisa A. Gottlieb |
| collection | DOAJ |
| description | Atrial fibrillation (AF) often requires invasive treatment by ablation to decrease symptom burden. The pulmonary veins (PV) are thought to trigger paroxysms of AF, and ablative PV isolation (PVI) is a cornerstone in AF treatment. However, incomplete PVI, where electrical conduction between the PV and left atrium (LA) is maintained, is curative of AF in a subset of patients. This implies that an antiarrhythmic effect other than electrical isolation between the PV and LA plays a role in AF prevention in these patients. We reason that the PV myocardium constitutes an arrhythmogenic substrate conducive to reentry in the patients with curative incomplete PVI. This PV substrate is amenable to ablation, even when conduction between the LA and PV persists. We propose that PV ablation strategies are differentiated to fit the arrhythmogenic mechanisms in the individual patient. PV substrate modification in patients with PV reentry may constitute a new therapeutic approach that is potentially simpler and more effective, in this subgroup of patients. |
| first_indexed | 2024-03-13T09:53:40Z |
| format | Article |
| id | doaj.art-86ec041957af4c7dabd45d5b2a5ce11d |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-03-13T09:53:40Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-86ec041957af4c7dabd45d5b2a5ce11d2023-05-24T04:38:37ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2023-05-011410.3389/fphys.2023.11573381157338Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillationLisa A. Gottlieb0Lisa A. Gottlieb1Lisa A. Gottlieb2Lukas R. C. Dekker3Lukas R. C. Dekker4Ruben Coronel5Ruben Coronel6Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, DenmarkElectrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, FranceAmsterdam UMC, location Academic Medical Centre, Department of Experimental Cardiology, University of Amsterdam, Amsterdam, NetherlandsDepartment of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, NetherlandsDepartment of Cardiology, Catharina Hospital, Eindhoven, NetherlandsElectrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, FranceAmsterdam UMC, location Academic Medical Centre, Department of Experimental Cardiology, University of Amsterdam, Amsterdam, NetherlandsAtrial fibrillation (AF) often requires invasive treatment by ablation to decrease symptom burden. The pulmonary veins (PV) are thought to trigger paroxysms of AF, and ablative PV isolation (PVI) is a cornerstone in AF treatment. However, incomplete PVI, where electrical conduction between the PV and left atrium (LA) is maintained, is curative of AF in a subset of patients. This implies that an antiarrhythmic effect other than electrical isolation between the PV and LA plays a role in AF prevention in these patients. We reason that the PV myocardium constitutes an arrhythmogenic substrate conducive to reentry in the patients with curative incomplete PVI. This PV substrate is amenable to ablation, even when conduction between the LA and PV persists. We propose that PV ablation strategies are differentiated to fit the arrhythmogenic mechanisms in the individual patient. PV substrate modification in patients with PV reentry may constitute a new therapeutic approach that is potentially simpler and more effective, in this subgroup of patients.https://www.frontiersin.org/articles/10.3389/fphys.2023.1157338/fullablationfocal arrhythmiasparoxysmal atrial fibrillationpulmonary veinpulmonary vein isolationreentry |
| spellingShingle | Lisa A. Gottlieb Lisa A. Gottlieb Lisa A. Gottlieb Lukas R. C. Dekker Lukas R. C. Dekker Ruben Coronel Ruben Coronel Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation Frontiers in Physiology ablation focal arrhythmias paroxysmal atrial fibrillation pulmonary vein pulmonary vein isolation reentry |
| title | Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation |
| title_full | Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation |
| title_fullStr | Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation |
| title_full_unstemmed | Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation |
| title_short | Arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation |
| title_sort | arrhythmia mechanism dependent pulmonary vein ablation in paroxysmal atrial fibrillation |
| topic | ablation focal arrhythmias paroxysmal atrial fibrillation pulmonary vein pulmonary vein isolation reentry |
| url | https://www.frontiersin.org/articles/10.3389/fphys.2023.1157338/full |
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