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Editor’s comments The contribution of the study by Oral et al. is that it demonstrates that chronic AF can be cured in a majority of cases. Chronic AF is considered to be a more difficult arrhythmia to ablate than paroxysmal AF. That is because in the latter case it is often sufficient to just target the triggers of the arrhythmia (eg, electrical isolation of the pulmonary veins), whereas in chronic AF both the trigger and substrate are targeted. The advantage of the circumferential pulmonary vein isolation procedure is that it potentially eliminates both the triggers and substrate. It should be noted that the procedure was performed on patients without structural heart disease, those who were less than or equal to 70 years of age, and those whose left atrial diameter was less than or equal to 55 mm. Therefore, the applicability of these data to the large number of elderly patients with chronic AF and structural heart disease is unknown. A randomized comparison of an ablation strategy versus an antiarrhythmic approach in this group of patients would also be informative. Finally, it is important to emphasize that in order to achieve a 74% ablation success at 12 months, nearly one third of patients require a second ablation procedure. As our understanding of the pathophysiology of AF further develops and with the advent of technologic improvements, the efficacy of this procedure should also improve.
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Lerman, B.B. Catheter ablation of chronic atrial fibrillation. Curr Cardiol Rep 9, 349–350 (2007). https://doi.org/10.1007/BF02938360
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DOI: https://doi.org/10.1007/BF02938360