John M. Mandrola, MD; Felipe Atienza, MD, PhD


February 10, 2014

In This Article

"Ablating All Over the Atria" Not the Way to Go

Dr. Mandrola: What conclusions do you make from this?

Dr. Atienza: The main conclusion is that in patients with persistent atrial fibrillation, this strategy doesn't work. It has no additional value. The procedure takes longer and has increased risk for complication s. In contrast, patients with paroxysmal atrial fibrillation are often quite young. Not only do we want to cure the patient, but we want to avoid complications. This minimally invasive technique uses less energy, and we ablate less. This strategy is as efficacious as CPVI, which is much more invasive in the sense that we ablate more, and has higher complication rates.

Dr. Mandrola: As far as the mechanism of atrial fibrillation, we still don't understand what is going on. Does your study help us understand it?

Dr. Atienza: The findings are in agreement with several other studies. First, they concur with previous animal studies; the design of our study was based on a long-lasting collaboration in translational research that we have with the laboratory of Dr. Jalife, who is an expert in atrial fibrillation research, and we were able to observe a similar behavior of dominant frequency as he did in his experiments. At the same time, in the clinical setting, our results are in agreement with those of Dr. Narayan from San Diego; using a slightly different way of analyzing the behavior of atrial fibrillation, he also found rotors maintaining atrial fibrillation and ablated them with focal applications of radiofrequency.[2]

Dr. Mandrola: Your work is consistent and confirmatory that the targeting of important rotors is really promising?

Dr. Atienza: I truly believe that is the way to go. Ablating all over the atria is not the way to go. It is not safe, or at least not as safe as it seems from the studies. Real life is different in the sense that complication rates are higher than reported, and the way to go is treating the mechanisms of the diseases. Our trial and the trials from Dr. Narayan's group are pointing to the direction that a mechanistically based treatment of atrial fibrillation is the way to go.

Dr. Mandrola: That is a very important and exciting message, and this is why your trial is so exciting. Thanks for being with us.


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