García-Villarreal OA

Language: English
References: 5
Page: 76-76
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I have read with great interest, the article by Kim et al. and I congratulate the authors for this important work. However, there are a number of crucial points that need clarification. Since the seminal work by Haïssaguerre et al., isolation of the pulmonary veins (PV) has been a fundamental part of all ablative procedures for atrial fibrillation (AF), regardless of its type. However, the triggers producing AF can be located not only inside the PV, but also in the left atrial antrum that contains these structures. Since the pathophysiological basis of paroxysmal and non-paroxysmal AF are totally different, the ablative approach for each should be correspondingly different.

REFERENCES

1. Kim D, Yu HT, Kim T-H, et al. Electrical Posterior Box Isolation in Repeat Ablationfor Atrial Fibrillation: A Prospective Randomized Clinical Study. JACC:Clinical Electrophysiology (2022). doi: 10.1016/j.jacep.2022.01.003.

2. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillationby ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66.

3. Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg2014;3:80-8.

4. Voeller RK, Bailey MS, Zierer A, et al. Isolating the entire posterior left atriumimproves surgical outcomes after the Cox maze procedure. J Thorac CardiovascSurg 2008;135:870-7.

5. Garcia-Villarreal OA. Pulmonary vein isolation for persistent atrial fibrillation.Long-term results. Asian Cardiovasc Thorac Ann 2015;23:665-9.