Since the publication of seminal work demonstrating ablation of AF triggers within the pulmonary veins, significant focus has been placed upon finding adjunctive AF mapping and ablation strategies to improve the targeted treatment of this arrhythmia. Presently, wide-area circumferential ablation to achieve pulmonary vein isolation has become the standard of care for catheter-based management. However, despite significant work, a comprehensive mechanistic understanding of the sustaining mechanisms of AF remains elusive. The present study from Nagase and colleagues provides important insight derived from a multielectrode catheter-based mapping algorithm regarding the spatial relationships between identified targets, regions of low voltage, and complex fractionated atrial electrograms. Being spatially distinct and distributed in both atria, they may represent novel targets for ablation therapy. Additional studies are required to better assess the impact of elimination of such foci.
Keywords: arrhythmia mapping; atrial fibrillation; catheter ablation.