a rapid evolution from targeting potentials inside the pulmonary veins, to pulmonary vein isolation, to antral isolation. This has been aided by the development of 3-D mapping systems, importing of cardiac computed tomography or magnetic resonance studies, irrigated-tip radiofrequency catheters and robotics. Despite these advances, the overall success rate for patients with paroxysmal AF for a single ablation procedure is in the range of 6070 percent. It is less successful for the persistent AF patient with an enlarged left atrium. In the March 2011 issue of The Triangle Physician, there was an article on a new hybrid AF procedure. This work was pioneered by Dr. Andy Kiser at FirstHealth Moore Regional Hospital in Pinehurst. Dr. Kiser started with an open-chest approach to assess the epicardial ablation device and to develop a lesion set. He then developed a minimally invasive approach through the pericardium. In collaboration with electrophysiologists, a hybrid approach was subsequently developed. The surgeon begins the ablation procedure epicardially, and then the electrophysiologist completes the various lines and tests for pulmonary vein isolation endocardially. With Dr. Kiser’s return to his alma mater, this work will be continued at the University of North Carolina at Chapel Hill. So what does the future hold? New catheter
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ablation devices are in development. Some use balloons to deliver a circumferential ablation around each pulmonary vein ostium. Other energy sources are being evaluated. Hybrid procedures are being developed and refined. A new class of agents targeting the IKur channels, found
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predominantly in atrial myocardium, are in
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development. And what does this mean for patients? Each patient is different. Some are asymptomatic
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and only require anticoagulation. A few only need a little more rate control. Many are devastated with AF and require restoration of sinus rhythm. With so many treatments now available, it is imperative that the treating physician be aware of the risks and benefits of each, and then tailor therapy to each patient.
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In the meantime, my kudos to all the researchers, basic science and clinical, who are continuing to explore new frontiers in
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atrial fibrillation.
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