Substrate Versus Trigger Ablation for Paroxysmal Atrial Fibrillation

Exclusion Criteria

• •atrial fibrillation from a reversible cause (e.g., surgery, hyperthyroidism, pericarditis)
• •cardiac or thoracic surgery within the past 180 days
• •AF secondary to electrolyte imbalance, thyroid disease
• •contraindication to Heparin
• •Contraindication to Warfarin or other novel oral anticoagulants
• •history of significant bleeding abnormalities
• •history of significant blood clotting abnormalities, systemic thrombi or systemic embolization
• •ASD closure device, LAA closure device, prosthetic mitral or tricuspid valve
• •atrial clot/thrombus on imaging such as on a trans-esophageal echocardiogram (TEE) within 72 hours of the procedure
• •intramural thrombus or other cardiac mass that may adversely effect catheter introduction or manipulation
• •significant pulmonary embolus within 6 months of enrollment
• •acute illness or active systemic infection or sepsis that may ordinarily warrant postponement of the procedure
• •history of recent cerebrovascular disease (stroke or TIA) or systemic thromboembolism within \< 6 months
• •NYHA classes III, IV
• •heart failure that is not stable on medical therapy
• •pulmonary edema, that may make planned anesthesia or sedation difficult
• •stable/unstable angina or ongoing myocardial ischemia
• •myocardial infarction (MI) within the past three months
• •structural heart disease of clinical significance including:
• •* congenital heart disease where the abnormality or its correction prohibit or increase the risk of ablation
• •* acquired heart disease that may increase risk of ablation, such as significant ventricular septal defect post myocardial infarction
• •* rheumatic valve disease, since this produces a unique AF phenotype
• •* extreme left atrial enlargement (LA volume index \> 60 ml/m2) in whom PVI has low success and 55 mm baskets are too small for the atria
• •cardiac transplantation or other cardiac surgery planned within the 12 month followup period of the trial
• •life expectancy less than 12 months (the followup period of the trial)
• •significant pulmonary disease (e.g., COPD) or any other disease that significantly increase the risk to the patient from sedation or anesthesia
• •untreatable allergy to contrast media
• •at time of ablation procedure, clinically significant abnormalities in serum potassium, sodium, magnesium or other electrolytes that affect the suitability of the patient for ablation at that time