Defragmentation in ablative AF treatment: is our knowledge too fragmented?

Excerpt

Our current knowledge of the arrhythmic genesis of atrial fibrillation (AF) converges to the AF multiple wavelets concept of Moe and Allessie of the 1970s, which was further elaborated by many other investigators. Around 1990, spontaneous automaticity arising in muscular sleeves of pulmonary veins was documented by Haissaguerre and his rhythm experts of Bordeaux. Therefore, it made sense that after failed antiarrhythmic drug treatment to prevent or suppress AF, these concepts were translated into invasive therapy. Around 1985, cardiac surgeons Cox and Guiraudon were the first to eliminate the type of AF based on the multiple wavelets concept with different cut-and-sew approaches. Due to the large impact of surgery, catheter ablation to eliminate automaticity with pulmonary vein isolation and (gradually more) atrial ablation lines followed. The assumption that the percutaneous approach would be a promising, less aggressive alternative for surgery, however, evaporated due to the inferior long-term results compared with current minimal invasive surgery [1]. These disappointing results conceivably prompted many groups to explore additional measures for the eradication of AF, such as energy sources different from radiofrequency, ablation of the cardiac nervous ganglia and elimination of zones of slow or non-uniform conduction guided by voltage differences or fragmentation mapping of atrial tissue [2]. …