Prashanthan Sanders

Chapter 112 – Catheter Ablation of Atrial Fibrillation: Triggers and Substrate

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans, occurring in 2% of the unselected adult population, increasing with each decade of life to a prevalence of 5.9% in the population older than 65 years. It results in an increased mortality rate and significant morbidity rate related to thromboembolic stroke, loss of atrial systole, and tachycardia-mediated atrial and ventricular cardiomyopathy. 1 Management strategies have been two tiered, either using palliative measures of rate control coupled with anticoagulation or the restoration and maintenance of sinus rhythm. Emerging evidence suggests that the pharmacologic maintenance of sinus rhythm has limited efficacy and value, at least in older patients and in those with persistent AF or structural heart disease. 2 3 4 Consequently, there is heightened interest in the nonpharmacologic, catheter-based approaches to maintain sinus rhythm that may prevent the significant adverse consequences associated with this arrhythmia. This chapter focuses on the current mapping techniques and the advantages and limitations of catheter ablation techniques targeting the triggers and substrate of AF.