- Atrial fibrillation (AF) is one of the 20th-century epidemics. Over the past 2 decades, significant advances have been made in the treatment of AF, the last being percutaneous ablation. Haissaguerre et al1 showed that AF triggers often originate from the thoracic veins. The goal of present-day AF ablation is to electrically “disconnect” the pulmonary veins (PVs) from the rest of the left atrium (LA) by ablating around the origin of the veins.2 At present, at least two techniques are used for AF ablation.
- The goals of therapy for atrial fibrillation (AF) are elimination of symptoms and improvement in quality of life; prevention of complications such as thromboembolic events and tachycardia-mediated cardiomyopathy; and, at least in theory, improvement in survival.
- Curative catheter ablation of atrial fibrillation (AF) began with the recognition of ectopic impulses triggering AF, originating dominantly from the pulmonary veins (PV). Electrical isolation of the PV from the LA was proposed to eliminate these triggers from the PV and is now performed with the aid of a circumferential PV mapping (lasso) catheter. In addition to the initiating role of the PV, this structure is also critical as a substrate maintaining AF.1 The importance of PV isolation in AF ablative therapy therefore remains unchanged since the development of this technique whether it is for paroxysmal, persistent or permanent AF.
- Transseptal catheterization through the atrial septum has become a useful skill for electrophysiologists. The challenge for a successful transseptal puncture is positioning the Brockenbrough needle at the thinnest aspect of the atrial septum, the membranous fossa ovalis, guided by either intracardiac echocardiography (ICE) or fluoroscopy.1–5 This article describes the technical aspects of performing a transseptal puncture using ICE and fluoroscopic guidance.