3D radiofrequency ablation in persistent atrial fibrillation

Introduction: Radiofrequency ablation using the elec-tro anatomical mapping system is a premise for the successful treatment of atrial fibrillation. Currently, pulmonary vein isolation is considered superior to an-tiarrhythmic therapy and can be used as the first the-rapeutic choice for symptomatic paroxysmal atrial fi-brillation, whereas for persistent atrial fibrillation it is still not universally accepted as a gold standard.
Case presentation: A 68-year-old patient known for persistent atrial fibrillation with intense symptomato-logy, converted to a history of sinus rhythm with relap-se under antiarrhythmic medication opts for ablation of atrial fibrillation in the 3D system at the Recovery Hospital Cluj-Napoca, Cardiology Department.Cardi-ovascular risk factors include dyslipidemia, overweight. In non-invasive assessment, on ECG the FiA is average with no ischemic changes and echocardiography revea-led a slightly dilated left atrium without any other echo-cardiographic changes. Transesophageal echography was performed with confirmation of lack of spontane-ous contrast or thrombi in the left atrium or left auricle. In the angio CT scan of the left atrium and pulmonary veins, two distinct pulmonary veins on the right side were revealed, and a common pulmonary trunk on the left side.
In the invasive assessment by electrophysiologi-cal study using the NAVI-X 3D mapping system, the left anatomical map was performed initially, which was similar to that obtained by angio CT reconstruc-tion performed prior to the procedure. The electrical potentials at the level of the 3 pulmonary veins were identified and electrically isolated.Thereafter, a voltage map was completed showing the areas of fibrosis in the roof and in the anterior part of the left atrium. Ablation tiers were applied at the healthy-fibrosis site interface. At the end of the procedure, electrical conversion was achieved at sinus rhythm. At post-ablation Holter ECG 24h monitoring and 2 months post-ablation, there is a complete disappearance of arrhythmia and sympto-matology.
Conclusions: Isolation of the pulmonary veins remains the cornerstone in catheter ablation of atrial fibrillation. Regarding the ablation of persistent atrial fibrillation, there are several extensive ablation strategies that can be considered.Thus, in the case of the remodeling of the left atrium, it was assessed invasively by performing the voltage map and identifying the low voltage areas with their isolation, this being one of the accepted methods for the treatment of persistent atrial fibrillation. Key words: electro anatomical cartography in NAVI-X 3D system, persistent atrial fibrillation, common pulmonary trunk.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)