4.5 Clinical implications
We previously reported successful ExTRa Mapping and LGE-MRI guided
ablation as a case report.22 In that case, RF
applications at NPAs on the bottom of the posterior LA outside the box
lesion could convert AF to common atrial flutter. The tissue properties
of the NPAs were G2. That indicated that an NPA with a heterogenous
fibrotic tissue property (G2) was considered as the most important
ablation target. The question is whether we should consider the PAs with
G2 properties as ablation targets. In this study, the PAs with G2
properties were also found. Although such tissue properties were not
“currently” associated with AF rotors, we speculated that they could
potentially harbor AF rotors in the near future due to the progression
of myocardial fibrosis. To improve the long-term outcome after catheter
ablation, we should consider that these PAs with G2 properties could be
acceptable as ablation targets. Finally, we strongly recommended that
the dense fibrotic tissue should be excluded from the ablation targets.