Catheter ablation of atrial fibrillation continued to be the theme of greatest interest at the tenth anniversary meeting of the annual Boston Atrial Fibrillation Symposium, held on January 14–15, 2005. Clinical investigators and basic scientists from North America, Europe, Asia, and South America exchanged their data and perspectives on different procedural approaches to catheter and surgical ablation of atrial fibrillation (see Appendix). The following is a synopsis of key issues discussed at the symposium. All quoted assertions of individuals have been cleared by the authors with each person.
The therapeutic mechanisms of action and target substrates of catheter ablation for atrial fibrillation are now thought to be more complex than previously recognized. While catheter ablation for atrial fibrillation was initially focused on pulmonary vein isolation, more recently the net has widened substantially to include alternative or supplementary approaches. Four different approaches to catheter ablation of atrial fibrillation are emerging:
- Isolation of the triggers and perpetuating reentrant circuits residing in the pulmonary veins (pioneered by Jais and Haissaguerre).
- Disruption of the substrate for perpetuating rotors in the antra of the pulmonary veins and the posterior left atrium (pioneered by Pappone).
- Targeted ablation of ganglionated autonomic plexi in the epicardial fat pads (pioneered by Platt, Jackman, and Scherlag).
- Disruption of putative dominant rotors in the left and right atria proper as recognized by high-frequency complex fractionated electrograms during mapping of atrial fibrillation (pioneered by Nadamanee).
