Conclusion
Contributions from non-PV triggers have a significant influence on the
progression of PersAF and LSPAF, making it imperative to execute other
strategies beyond PVI. With the development of novel approaches, more
RCTs are needed to compare each strategy in a head-to-head fashion and
to evaluate their efficacy and safety. Importantly, current evidence
seems to demonstrate that the use of scar, CFAE and FIRM ablation have
no role in the current management of non-PAF, as there is no evidence
demonstrating improved outcomes but they are associated with
significantly higher risk of procedure related complications. Other
strategies, including PWI and LAAEI, are currently being studied and may
play a significant role in reducing AF recurrence. Further randomized
controlled trials are needed to guide the most appropriate therapy in
this group of patients.