Elimination of triggers without an additional substrate modification is not sufficient in patients with persistent atrial fibrillation

Junbeom Park, Hui Nam Pak

Research output: Contribution to journalReview article

1 Citation (Scopus)


Atrial fibrillation (AF) is a multifactorial disease with complex pathophysiology. Although restoring sinus rhythm delays the progression of atrial remodeling, non-pharmacologic intervention, such as radiofrequency catheter ablation (RFCA), should be done based on the background pathophysiology of the disease. While circumferential pulmonary vein isolation (CPVI) has been known to be the cornerstone of AF catheter ablation, a clinical recurrence rate after CPVI is high in patients with persistent AF (PeAF). Step-wise linear ablation, complex fractionate atrial electrogram (CFAE)-guided ablation, rotor ablation, ganglionate plexus ablation, and left atrial appendage isolation may improve the ablation success rate after CPVI. But, there are still substantial AF recurrences after such liberal atrial substrate ablation, and current ablation techniques regarding substrate modification still have limitations. Therefore, more understanding about AF pathophysiology and early precise intervention may improve clinical outcome of AF management. Keeping in mind "more touch, more scar," operators should generate most efficient substrate modification to achieve better long-term clinical outcome.

Original languageEnglish
Pages (from-to)33-39
Number of pages7
JournalJournal of Atrial Fibrillation
Issue number5
Publication statusPublished - 2015 Feb 1


All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this