Is There Still a Role for Right Atrial Ablation in Patients with Atrial Fibrillation?
Radiofrequency (RF) transcatheter ablation has been recently proposed to cure atrial fibrillation (AF). Initial studies tried to replicate the surgical “maze” procedure, performing linear lesions in the right atrium (RA) and/or the left atrium [1-5]. The first report of RF catheter ablation suggested that linear lesions in the RA are able to cure AF . Additional studies have been done using only right atrial ablation to prevent AF recurrence, with varying results but without serious complications [2-5]. More recently, several reports have pointed to the importance of the posterior region of the left atrium, particularly the pulmonary veins, as a critical area in the initiation and maintenance of AF [6-10]. However, the approaches used vary, the reproducibility of the results is uncertain, and the studies are not controlled. Furthermore, these ablative therapies are not without risks . Haïssaguerre et al.  reported a success rate of 71% with a 3% incidence of pulmonary vein stenosis in patients with paroxysmal AF who underwent focal ablation in the pulmonary veins. A different approach, circumferential pulmonary vein ablation, proved to be effective in 80% of patients, with an 0.8% incidence of major complications . Nowadays, the low efficacy of right atrial ablation procedures is generally accepted, but some issues remain to be clarified. Can we increase the efficacy of the linear lesions in the RA with new mapping systems? What is the most effective lesion design in the RA, and what is the effect of these lesions on quality of life?
KeywordsAtrial Fibrillation Pulmonary Vein Catheter Ablation Superior Vena Cava Paroxysmal Atrial Fibrillation
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