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J Korean Med Assoc > Volume 51(4); 2008 > Article
Kim: Drug Therapy and Catheter Ablation for Atrial Fibrillation

Abstract

In all clinical trials comparing rate versus rhythm control of atrial fibrillation (AF) by drugs, there was no survival benefit associated with a rhythm control strategy. Currently used antiarrhythmic drugs are not only frequently ineffective at eliminating AF, but may be life threatening in some patients. Catheter ablation (CA) of AF has evolved rapidly and has become accepted as one of the therapeutic modalities for controlling AF. The effective strategies for CA of AF consist of pulmonary vein isolation (PVI) and/or complete encirclement around PVs with or without additional ablation lines. Selection of patients, who may be benefited by CA or not, is an important issue. Precise electroanatomic mapping for the triggers and the substrate of the atria is central for customizing ablation target and for enhancing efficacy of CA for AF. With further development of new energy sources of ablation, cardiac imaging, navigation, and mapping systems, the CA can be simplified and standardized, which may enable the CA to become more effective, safer, and more applicable to many different subsets of AF.

References

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Figure 1
Selection of antiarrhythmic drugs for the maintenance of sinus rhythm. ACC/AHA/ESC Practice Guidelines 2006.
jkma-51-317-g001-l.jpg
Figure 2
Dissociated pulmonary vein potential (PVP, *) from the let atrium after ablation.
jkma-51-317-g002-l.jpg
Figure 3
Number of catheter ablation of atrial fibrillation at Korea University Medical Center (KUMC, 1998~2007, n=680).
jkma-51-317-g003-l.jpg
Figure 4
Long-term freedom from AF recurrence in patients with paroxysmal AF and persistent AF at KUMC (n=533).
jkma-51-317-g004-l.jpg
Figure 5
Selective arrhythmogenic pulmonary vein isolation (A) and empirical 4 pulmonary veins isolation (B). Pak HN, et al. J Cardiovasc Electrophysiol 2008 (In press).
jkma-51-317-g005-l.jpg
Figure 6
Atrial fibrillation recurrence rate after selective arrhythmogenic pulmonary vein isolation (SePVI) and empirical 4 pulmonary veins isolation (EmPVI). Pak HN, et al. J Cardiovasc Electrophysiol 2008 (In press).
jkma-51-317-g006-l.jpg
Figure 7
Automated map of complex fractionated atrial electrograms (CFAEs) during atrial fibrillation (6 seconds segment). The areas of white and red color illustrate CFAE with cycle length <80ms and <120ms, respectively.
jkma-51-317-g007-l.jpg
Figure 8
Linear ablation along the complex fractionated atrial electrograms (CFAEs, white color denotes cycle length <120ms) during atrial fibrillation. Panel A shows automated CFAE map at baseline and panel B shows the summary of ablation of the antra of 4 pulmonary veins and linear extension to the areas showing CFAE.
jkma-51-317-g008-l.jpg
Figure 9
Voltage map after isolation of 4 pulmonary veins and linear ablation at the roof and perimitral isthmus in patients with chronic, persistent atrial fibrillation. The voltage of the areas within the ablation lines convert to less than 0.2mV defining as gray color.
jkma-51-317-g009-l.jpg


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