Atrial fibrillation (AF) often recurs after ablative therapy. In our patient, intraoperative epicardial mapping during therapy- resistant AF revealed highly dissociated atrial conduction patterns and that long lines of conduction block throughout the entire atria. Given the extensiveness of the substrate, it is not surprising that ablations were not successful. Conduction patterns during therapy-resistant atrial fibrillation (AF) are highly dissociated and show long lines of conduction block. As long as the presence and extensiveness of the arrhythmogenic substrate underlying AF remains poorly understood and cannot be evaluated in the individual patient, none of the present available antiarrhythmic treatment modalities will be effective.

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Clinical Case Reports
Department of Cardiology

Lanters, E., Knops, S., Kik, C., & de Groot, N. (2019). Atrial fibrillation: A never ending story?. Clinical Case Reports. doi:10.1002/ccr3.2415