PLS as AF substrate
LGE-MRI based computer simulation model demonstrated that meandering
re-entrant AF driver was localized in boundary zones between fibrotic
and non-fibrotic tissue characterized with high fibrosis density and
entropy where the lower local conduction velocity was
documented.20,22Furthermore, they has demonstrated that the residual fibrosis after
catheter ablation might be attributable to preserved re-entrant drivers
and the emergence of new re-entrant
driver.23 This strongly
indicated that the all fibrosis with high density and entropy were
possible ablation targets. Therefore, the RF application at the PLS was
continued, even in cases where AF termination was achieved during the
procedure. Recently, Boyle et al. had presented the computationally
guided personalized targeted ablation as a proof-of -concept feasibility
study.7 Furthermore,
they suggested that LGE-MRI based computationally guided ablation could
provide not only accurate prediction of AF ablation targets but could
overcome the prolonged procedure time and higher radiation exposure due
to the difficulty of a conventional mapping of atrial electrical
activity. In our study, both procedure time and fluoroscopy time ware
acceptable as compared to that of conventional ablation procedure,
because additional target site was predefined by the preprocedural
LGE-MRI and no further mapping was necessary during the procedure. We
would hope that the PLS ablation could improve the rhythm outcome in
persistent AF patients without increasing of the procedure time and
radiation exposure.