Current strategies for non-pharmacological therapy of long-standing persistent atrial fibrillation

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  • Yamane Teiichi
    Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine

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  • Current strategies for non‐pharmacological therapy of long‐standing persistent atrial fibrillation

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Non-pharmacological rhythm control of atrial fibrillation (AF) is becoming increasingly important in our aging society. Advancement of catheter ablation techniques in the last decade has provided a cure for AF patients, with a nearly established efficiency for paroxysmal cases. However, since ablation of persistent/chronic AF cases is still challenging, early treatment of paroxysmal AF before transformation to the persistent/chronic form is mandatory. Although there is a consensus that pulmonary vein isolation is the first-line approach for ablation of long-standing persistent AF, similar to that for paroxysmal AF, there are still wide variations in the adjunctive approach to modify the atrial substrate of persistent AF (anatomical linear ablation, electrogram-based complex fractionated atrial electrogram ablation, ganglionated plexus ablation, etc.). Since data comparing the effectiveness of these adjunctive approaches are still lacking, large-scale controlled trials evaluating the effect of catheter ablation in diverse patient populations on a long-term basis are needed to establish the appropriate approach for long-standing persistent AF. Furthermore, the development of de novo ablation methods (new energies, new targets, etc.) is expected to improve ablation outcome in patients with long-standing persistent AF.

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