AV node ablation in AF patients a Class of recommendation. b Level of evidence. AF = atrial fibrillation; AV = atrioventricular; CRT = cardiac resynchronization therapy; LV = left ventricular; LVEF = left ventricular ejection fraction; NYHA = New York Heart Association.
Wood M et al. Circulation 2000;101:1138-1144 Quality of life and symptoms after AV junctional ablation and pacing
Principles of antiarrhythmic drug therapy to maintain sinus rhythm 1. Treatment is motivated by attempts to reduce AF-related symptoms. 2. Efficacy of antiarrhythmic drugs to maintain sinus rhythm is modest. 3. Clinically successful antiarrhythmic drug therapy may reduce rather than eliminate recurrence of AF. 4. If one antiarrhythmic drug ‘fails’ a clinically acceptable response may be achieved with another agent. 5. Drug-induced proarrhythmia or extra-cardiac side-effects are frequent. 6. Safety rather than efficacy considerations should primarily guide the choice of antiarrhythmic agent.
Current approaches to catheter ablation Catheter ablation is currently based on four main strategies: Isolation of the triggers and perpetuating re-entrant circuits located in the pulmonary veins; Disruption of the substrate for perpetuating rotors in the antra of the pulmonary veins; Disruption of putative dominant rotors in the left and right atria, recognized by high-frequency complex fractionated electrograms during mapping of AF. Targeted ablation of ganglionated autonomic plexi in the epicardial fat pads.