Ablation of Longstanding Persistent Atrial Fibrillation

To prevent recurrence of paroxysmal atrial fibrillation (AF, events <7 days) isolation of pulmonary vein (PV) triggers results in success rates of up to 0.9 (i.e. 90%). Recent evidence suggests that complete circumferential antral ablation is not even necessary for PV isolation. When AF persists beyond one week, electrical and anatomic substrate remodeling typically occurs. Initially, when remodeling is slight, the arrhythmia can be terminated by PV isolation with only a few left atrial ablation lesions required in addition. However if longstanding persistent atrial fibrillation is present (defined as event duration > 6 months or > 1 year) greater left atrial substrate modification is necessary