Atrial fibrillation: Novel insights into mechanisms, clinical manifestations and management

The etiology of atrial fibrillation (AF) is diverse and complex and its sequelae can have a substantial impact on mortality, quality of life and comorbid conditions. The present thesis reports how peri-infarction AF can be predicted and which AF patients have an increased risk of mortality. AF is also associated with an increased risk of inappropriate intracardiac cardioverter defibrillator (ICD) shock, and thereby associated with a reduced quality of life and ICD function. The present thesis covers a novel technique, using programmed stimulation of parasympathetic fibers to reduce atrioventricular node conduction and prevent inappropriate ICD shocks.

Ablation has become a class 1 indication for paroxysmal AF. However, patients still develop both arrhythmia recurrences and complications. The present thesis covers the implementation of novel techniques in the field of AF ablation, the procedural characteristics and ablation outcome. Furthermore, this thesis covers the issues associated with electrogram-based ablation of persistent AF, and uncovers potential causes for the contrasting results between previously performed studies. Finally, the impact of tissue characterization and geometry on ablation outcome is reported, suggesting that this characterization can be used to tailor ablation strategy.