Ablation of Driver Domains During Persistent Atrial Fibrillation: A Call for More Understanding
In this issue of Circulation, readers will find a fascinating study presented by Dr. Haissaguerre and several members of a promising and newly erected Institute for Cardiovascular Research located in Bordeaux (France): the LIRYC, ("L'institut de Rythmologie de Modélisation Cardiaque", The Institute for Arrhythmia and Computer Modeling Research).1 This is yet another pioneering contribution from the Bordeaux group which, if confirmed, may improve the management of patients with persistent atrial fibrillation (AF). AF is commonly classified as paroxysmal (PAF) or persistent (PsAF), depending on the duration of the arrhythmic episodes, fewer or more than 7 days.2 PsAF may also be sub-classified as long-standing persistent (LPsAF) when fibrillation has been continuous for more than a year.2 In the late nineties, Dr. Haissaguerre and team's seminal work indicated that, in patients with PAF, a catheter ablation procedure may be targeted at discrete pulmonary vein (PV) electrical foci and that PV electrical isolation from the remainder of the atrial muscle may prevent AF re-initiation.3,4 While the exact nature of PV foci has never been fully elucidated, this procedure proved successful in terminating AF, and in preventing its recurrence.5,6
- Received July 10, 2014.
- Accepted July 14, 2014.