Atrial fibrillation (AF) is the most common sustained heart rhythm disturbance. Approximately 25% of individuals aged 40 or above in industrialized countries will experience AF at some point. AF is strongly linked to severe health complications and a higher risk of mortality. Notably, AF is responsible for 20% of strokes among individuals aged 60 years or older.
Percutaneous catheter ablation therapy improves the quality of life for AF patients much more effectively than anti-arrhythmic drugs. Pulmonary vein isolation (PVI) is the cornerstone of current ablation techniques. PVI has proven effective in reversing paroxysmal AF. However, ablation significantly reduces efficacy in patients with persistent or long-standing persistent AF. The success rate of a single ablation procedure in achieving long-term results is less than 29%. Thus, relying solely on PVI proves inadequate for patients with the sustained subtypes of AF. To address this challenge, additional ablation lesions that target the underlying substrates responsible for maintaining fibrillation are necessary. However, no existing ablation strategies tested in randomized trials have exhibited superiority over PVI alone.
It remains imperative to improve our understanding of AF mechanisms and to explore innovative approaches and techniques to enhance the effectiveness of ablation therapy for persistent or long-standing persistent AF. By developing novel strategies that specifically target the substrate maintenance of fibrillation, we can strive for enhanced outcomes and improved long-term success in treating patients with AF.
This study endeavors to provide a comprehensive summary of the recent advancements, particularly focusing on the utilization of computer models and novel computational approaches to enhance our understanding of AF mechanisms and improve treatment strategies. By synthesizing the latest research findings, this review aims to shed light on the current state of knowledge regarding AF pathophysiology and therapeutic interventions, as well as to outline future directions for research and clinical practice.