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Different strategies of catheter ablation of atrialfibrillation for improving clinical outcomes

Authors: A.V. Kozlov, S.S. Durmanov

Company: Federal Center of Cardiovascular Surgery of the Ministry of Health of the Russian Federation, ulitsa Stasova, 6, Penza, 440071, Russian Federation

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DOI: https://doi.org/10.24022/1997-3187-2017-11-4-348-360

For citation: Kozlov A.V., Durmanov S.S. Different strategies of catheter ablation of atrial fibrillation for improving clinical outcomes. Kreativnaya Kardiologiya (Creative Cardiology). 2017; 11 (4): 348–60 (in Russ.). DOI: 10.24022/1997-3187-2017-11-4-348-360

Received / Accepted:  14.07.2017/11.08.2017

Keywords: atrial fibrillation radiofrequency ablation isolation of the pulmonary veins efficiency

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Abstract

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Various strategies of radiofrequency ablation (RFA) are considered: segmental osteal ablation of the pulmonary veins, antral isolation, linear effects in the left atrium, ablation of complex fractionated atrial electrograms (CFAEs), ablation of the ganglionic plexuses, stepwise ablation, ablation of the “rotors” and focal impulses. Currently, antral isolation of pulmonary veins (PV) is considered to be the most advantageous strategy of AF ablation, as it allows to influence a greater number of mechanisms that cause and support arrhythmia. There are conflicting data, and currently the role of additional ablations in improving clinical outcomes remains controversial and requires further research. Recovery in isolated pulmonary veins is almost universal finding in patients undergoing repeated RFA of AF, although the connection between electrical reconnection and return of arrhythmia remains unclear. Several methods are considered to increase the probability of creating a permanent isolation of the mouths of PV: increasing the waiting time after acute isolation of PV and re-ablation of emerging “breakthroughs” of excitation, high-amplitude stimulation from the mapping catheter along the created line of injury and reablation of sites with preserved excitability, adenosine administration detection of concealed conduction, the use of ablative catheters with technology to control the force of contact with tissue to create a more resistant to myocardial lesion. Isolation of the mouths of PV is the only method with proven effectiveness in the interventional treatment of AF. At the moment there is no method that provides 100% permanent isolation of pulmonary veins after a single procedure.

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About Authors

  • Kozlov Aleksandr Viktorovich, Cardiologist, orcid.org/0000-0002-0529-0081;
  • Durmanov Sergey Semenovich, Cand. Med. Sc., Head of Department, orcid.org/0000-0002-4973-510X

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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