4.5 Clinical implications
We previously reported successful ExTRa Mapping and LGE-MRI guided ablation as a case report.22 In that case, RF applications at NPAs on the bottom of the posterior LA outside the box lesion could convert AF to common atrial flutter. The tissue properties of the NPAs were G2. That indicated that an NPA with a heterogenous fibrotic tissue property (G2) was considered as the most important ablation target. The question is whether we should consider the PAs with G2 properties as ablation targets. In this study, the PAs with G2 properties were also found. Although such tissue properties were not “currently” associated with AF rotors, we speculated that they could potentially harbor AF rotors in the near future due to the progression of myocardial fibrosis. To improve the long-term outcome after catheter ablation, we should consider that these PAs with G2 properties could be acceptable as ablation targets. Finally, we strongly recommended that the dense fibrotic tissue should be excluded from the ablation targets.