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.