Final Remarks
Despite the available evidence on the techniques, a standard ablative
approach in patients has not yet been elucidated. The figures summarize
the most up-to-date evidence on ablation strategies, with each study
being scored according to its design and methodology. The final score
for each method represents the overall strength of the evidence, either
in favor or otherwise. However, we also recommend for the selection of
any additional strategy to be guided by the operators’ experience, the
availability of technological resources (e.g., specialized mapping
software, contact force catheters), and patient characteristics.
Decreasing the number of unnecessary ablation lesions within the LA is
of paramount importance, as recurrent AT is generally associated with
previous lesions (123). As such, strategies that have consistently
demonstrated a lack of clinical benefit (i.e., CFAE ablation, CTI
ablation) should not be performed, except as a part of a study protocol.
Importantly, when managing patients with non-PAF the probability of
repeat procedures should be clearly explained to patients, as these
might increase the long-term success rate (124).
The ongoing PLEA trial (Systematic Evaluation of Ablation Techniques for
Non-Paroxysmal Atrial Fibrillation; NCT04216667) is a multicenter, RCT
that will offer further insight into the efficacy and safety of
different empirical ablation strategies in non-PAF.