PMC:6019327 / 169271-171367 JSONTXT

{"project":"2_test","denotations":[{"id":"28506916-26511713-45814732","span":{"begin":719,"end":722},"obj":"26511713"},{"id":"28506916-26511713-45814732","span":{"begin":719,"end":722},"obj":"26511713"},{"id":"28506916-26511713-29307992","span":{"begin":998,"end":1001},"obj":"26511713"},{"id":"28506916-26511713-29307992","span":{"begin":998,"end":1001},"obj":"26511713"},{"id":"28506916-25151631-29307993","span":{"begin":1103,"end":1106},"obj":"25151631"},{"id":"28506916-25151631-29307993","span":{"begin":1103,"end":1106},"obj":"25151631"},{"id":"28506916-17655662-29307994","span":{"begin":1406,"end":1409},"obj":"17655662"},{"id":"28506916-17655662-29307994","span":{"begin":1406,"end":1409},"obj":"17655662"},{"id":"28506916-26277862-29307995","span":{"begin":1632,"end":1635},"obj":"26277862"},{"id":"28506916-26277862-29307995","span":{"begin":1632,"end":1635},"obj":"26277862"},{"id":"28506916-26515166-29307996","span":{"begin":1636,"end":1639},"obj":"26515166"},{"id":"28506916-26515166-29307996","span":{"begin":1636,"end":1639},"obj":"26515166"},{"id":"28506916-26857907-29307997","span":{"begin":1640,"end":1643},"obj":"26857907"},{"id":"28506916-26857907-29307997","span":{"begin":1640,"end":1643},"obj":"26857907"},{"id":"T35964","span":{"begin":719,"end":722},"obj":"26511713"},{"id":"T80816","span":{"begin":719,"end":722},"obj":"26511713"},{"id":"T72034","span":{"begin":998,"end":1001},"obj":"26511713"},{"id":"T47405","span":{"begin":998,"end":1001},"obj":"26511713"},{"id":"T46312","span":{"begin":1103,"end":1106},"obj":"25151631"},{"id":"T17324","span":{"begin":1103,"end":1106},"obj":"25151631"},{"id":"T53977","span":{"begin":1406,"end":1409},"obj":"17655662"},{"id":"T11181","span":{"begin":1406,"end":1409},"obj":"17655662"},{"id":"T7145","span":{"begin":1632,"end":1635},"obj":"26277862"},{"id":"T43537","span":{"begin":1632,"end":1635},"obj":"26277862"},{"id":"T75799","span":{"begin":1636,"end":1639},"obj":"26515166"},{"id":"T78300","span":{"begin":1636,"end":1639},"obj":"26515166"},{"id":"T15419","span":{"begin":1640,"end":1643},"obj":"26857907"},{"id":"T74801","span":{"begin":1640,"end":1643},"obj":"26857907"},{"id":"T16505","span":{"begin":719,"end":722},"obj":"26511713"},{"id":"T77208","span":{"begin":719,"end":722},"obj":"26511713"},{"id":"T18141","span":{"begin":998,"end":1001},"obj":"26511713"},{"id":"T37602","span":{"begin":998,"end":1001},"obj":"26511713"},{"id":"T67628","span":{"begin":1103,"end":1106},"obj":"25151631"},{"id":"T45735","span":{"begin":1103,"end":1106},"obj":"25151631"},{"id":"T30231","span":{"begin":1406,"end":1409},"obj":"17655662"},{"id":"T75829","span":{"begin":1406,"end":1409},"obj":"17655662"},{"id":"T17974","span":{"begin":1632,"end":1635},"obj":"26277862"},{"id":"T87647","span":{"begin":1632,"end":1635},"obj":"26277862"},{"id":"T8650","span":{"begin":1636,"end":1639},"obj":"26515166"},{"id":"T70037","span":{"begin":1636,"end":1639},"obj":"26515166"},{"id":"T76884","span":{"begin":1640,"end":1643},"obj":"26857907"},{"id":"T14391","span":{"begin":1640,"end":1643},"obj":"26857907"}],"text":"This approach involves first isolating the PVs. A voltage map is then recorded during sinus rhythm, and the low voltage areas are identified and subsequently isolated according to the individual localization and extent. Efforts are made to connect these BIFA ablation lines to the initial PVI lines to prevent the production of small channels, such as is possible with CFAE or GP ablation. Using this approach, approximately one-third of the patients with persistent AF were identified as not having substantial LA fibrosis and, accordingly, only PVI was performed. This limited approach led to freedom from AF at 12 months with a single procedure in 69% of the patients and with only 1.2 procedures per patient in 85%.140 These results were comparable to patients with substantial fibrosis and subsequent BIFA ablation. In addition, in a small portion of patients with massive fibrosis (the strawberry), failure of the initial ablation was likely, and further ablation procedures were discouraged.140 Other investigators have also described a tailored substrate modification based on low-voltage areas.554 They used several strategies, including linear lines encircling of low-voltage areas, with demonstration of a significant reduction in local electrograms, defractionation, and/or loss of capture. Even earlier, isolation of the posterior wall at the level of the PVs without prior EAVM was introduced522; however, this strategy did not address the individual localization of the fibrotic disease at that time. Several other groups have recently reported on voltage-guided substrate modification in patients with persistent AF.555,556,557 The durability of RFC-induced isolating lesions is clearly still an issue. The same holds true for BIFA lines for substrate modification guided by EAVM. Recent technology improvements of point-by-point catheter approaches (e.g., CF measurement) could further pave the way for improving these approaches. However, the realization of the proposed strategies for BIFA substrate modification requires of the operator extensive manual skills and experience."}