Atrial fibrillation: Defining potential curative ablation targets

The concept that atrial fibrillation (or at least certain forms of the arrh ythmia) may be amenable to reversal or amelioration by transcatheter ablati on techniques has become increasingly accepted in recent years. As yet, how ever, the techniques being studied for ablation of atrial fibrillation addr ess neither known critical anatomic elements nor well defined electrophysio logic markers. The approaches, although essentially empirical, are conceptu ally based on the 'multiple wavelet' or 'focal origin' hypotheses. To date, addressing 'focal origin' atrial fibrillation by transcatheter ablation ha s been the more encouraging. However, as technology evolves, both in terms of catheter design and possibly endocardial mapping techniques, approaches to wavelet or rotor mechanisms may become similarly effective. This communi cation examines concepts regarding the manner in which atrial fibrillation is initiated and maintained. The goals are to better understand the encoura ging success of empirical ablation methods, and possibly derive insights wh ich may help refine ablation targeting in the future.