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Chen Shih-Ann, M.D., Taipei
Veterans General Hospital, National Yang-Ming
University, Taipei, Taiwan
Atrial
fibrillation
(AF) is
the most
common
arrhythmia
in the
elderly
people.
In the
recent
years,
several
pharmacologic
and
nonpharmacologic
approaches
have
been
developed
to
combat
AF. AF
can be
initiated
and
maintained
by rapid
focal
depolarization
or a
single
reentry
circuit
with
fibrillatory
conduction,
or
multiple
simultaneous
reentrant
wavefronts
(1). The
surgeon
knife or
catheter
mediated
"Maze"
procedure
in the
right,
left, or
right
plus
left
atria
create
several
linear
lesions
to
divide
the
atria
into
segments
too
small to
support
reentrant
activation.
Rapid
focal
firing
of
cardiomyocytes
within
the
thoracic
veins
(including
pulmonary
veins,
superior
vena
cava)
and
atrial
tissues
initiating
AF in
the
majority
of AF
patients
has led
to a new
era in
AF. The
sites of
firing
that
initiate
AF are
targeted
for
ablation,
or
isolated
from
left
atrium.
Thus the
paradigm
for
curing
AF by
catheter
ablation
includes
altering
the
substrate
for
aintaining
fibrillation
and
elimination
of the
triggers
for
initiating
fibrillation.
Several
studies
have
demonstrated
the
short to
long-term
follow-up
results,
and the
best
candidates
for this
invasive
procedure
would be
patients
without
significant
organic
heart
disease,
frequent
episodes,
and
refractory
to
multiple
antiarrhythmic
drugs.
How to
simplify
the
procedure,
prevent
complication,
and
decrease
recurrence
rate
would be
the most
important
issues
for
catheter
ablation
of AF in
the
present
stage.
Reference
-
Nattel
Stanley.
New
ideas
about
atrial
fibrillation
50
years
on.
Nature
2002;
415:219-226
-
Haissaguerre
M,
Jais
P,
Shah
DC,
Takahashi
A,
Hocini
M,
Quiniou
G,
Garrigue
S,
Mouroux
AL,
Metayer
PL,
Clementy
J.
Spontaneous
initiation
of
atrial
fibrillation
by
ectopic
beats
originating
in
the
pulmonary
veins.
New
Engl
J
Med
1998;
339:659-666.
-
Chen
SA,
Hsiung
MH,
Tai
CT,
Tsai
CF,
V.S
Prakash,
Yu
WC,
Hsu
TL,
Ding
YA,
Chang
MS.
Initiation
of
atrial
fibrillation
by
ectopic
beats
originating
from
the
pulmonary
veins:
electrophysiological
characteristics,
pharmacological
responses,
and
effects
of
radiofrequency
ablation.
Circulation
1999:
100:
1879-1886.
-
Chen
S.A.,
Haissaguerre
M,
Zipes
D.P.
Textbook:
Thoracic
Vein
Arrhythmias:
Mechanisms
and
Treatment,
2004.
-
Cappato
R,
Calkins
H,
Chen
SA,
Davies
W,
Iesaka
Y,
Kalman
J,
Kim
YH,
Klein
G,
Packer
D,
Skanes
A.
Worldwide
survey
on
the
methods,
efficacy,
and
safety
of
catheter
ablation
for
human
atrial
fibrillation.
Circulation.
2005;111:1100-1105.
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