When and how to target atrial fibrillation sources outside the pulmonary veins: A practical approach

  • Aman Chugh
    Address reprint requests and correspondence: Dr Aman Chugh, Samuel and Jean Frankel Cardiovascular Center, University of Michigan, 1500 E Medical Center Dr, SPC 5853, Ann Arbor, MI 48109.
    Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
    Search for articles by this author
      Visit the HRS Learning Center at www.hrsonline.org/HRJ-CME to earn CME credit through an online activity related to this article. Certificates are available for immediate access upon successful completion of the activity.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yoshida K.
        • Ulfarsson M.
        • Oral H.
        • Crawford T.
        • Good E.
        • Jongnarangsin K.
        • Bogun F.
        • Pelosi F.
        • Jalife J.
        • Morady F.
        • Chugh A.
        Left atrial pressure and dominant frequency of atrial fibrillation in humans.
        Heart Rhythm. 2011; 8: 181-187
        • Narayan S.M.
        • Krummen D.E.
        • Shivkumar K.
        • Clopton P.
        • Rappel W.J.
        • Miller J.M.
        Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial.
        J Am Coll Cardiol. 2012; 60: 628-636
        • Lim H.S.
        • Hocini M.
        • Dubois R.
        • et al.
        Complexity and distribution of drivers in relation to duration of persistent atrial fibrillation.
        J Am Coll Cardiol. 2017; 69: 1257-1269
        • Benharash P.
        • Buch E.
        • Frank P.
        • Share M.
        • Tung R.
        • Shivkumar K.
        • Mandapati R.
        Quantitative analysis of localized sources identified by focal impulse and rotor modulation mapping in atrial fibrillation.
        Circ Arrhythm Electrophysiol. 2015; 8: 554-561
        • Takahashi Y.
        • O'Neill M.D.
        • Hocini M.
        • et al.
        Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation.
        J Am Coll Cardiol. 2008; 51: 1003-1010
        • Hunter R.J.
        • Diab I.
        • Tayebjee M.
        • Richmond L.
        • Sporton S.
        • Earley M.J.
        • Schilling R.J.
        Characterization of fractionated atrial electrograms critical for maintenance of atrial fibrillation: a randomized, controlled trial of ablation strategies (the CFAE AF trial).
        Circ Arrhythm Electrophysiol. 2011; 4: 622-629
        • Di Biase L.
        • Burkhardt J.D.
        • Mohanty P.
        • et al.
        Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial.
        J Am Coll Cardiol. 2016; 68: 1929-1940
        • Hocini M.
        • Nault I.
        • Wright M.
        • et al.
        Disparate evolution of right and left atrial rate during ablation of long-lasting persistent atrial fibrillation.
        J Am Coll Cardiol. 2010; 55: 1007-1016
        • Yoshida K.
        • Chugh A.
        • Good E.
        • et al.
        A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation.
        Heart Rhythm. 2010; 7: 295-302