Imaging in percutaneous ablation for atrial fibrillation

      Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high, although they are associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transesophageal and intracardiac echocardiography, computed tomography and magnetic resonance imaging, which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation, and ostial size) to facilitate position and size of catheters and reduce procedure time, as well as examination of the left atrium (presence of thrombi, dimensions, and volumes). Imaging after the percutaneous ablation is important for the assessment of the overall success of the procedure and to reveal potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for the preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as for the long-term follow-up of these patients.
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