{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:02:19Z","timestamp":1791388939455,"version":"4.3.3"},"reference-count":70,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial\u2013endocardial approaches to posterior wall isolation or ablation.<\/jats:p>","DOI":"10.3390\/jcm10143129","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T23:28:30Z","timestamp":1626391710000},"page":"3129","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies"],"prefix":"10.3390","volume":"10","author":[{"given":"Riyaz A.","family":"Kaba","sequence":"first","affiliation":[{"name":"Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George\u2019s University of London and St. George\u2019s University Hospitals NHS Foundation Trust, London SW17 0QT, UK"},{"name":"Ashford and St. Peter\u2019s Hospitals NHS Foundation Trust, Surrey KT16 0PZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Momin","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George\u2019s University of London and St. George\u2019s University Hospitals NHS Foundation Trust, London SW17 0QT, UK"},{"name":"Ashford and St. Peter\u2019s Hospitals NHS Foundation Trust, Surrey KT16 0PZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2536-2871","authenticated-orcid":false,"given":"John","family":"Camm","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George\u2019s University of London and St. George\u2019s University Hospitals NHS Foundation Trust, London SW17 0QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1161\/01.CIR.92.7.1954","article-title":"Atrial fibrillation begets atrial fibrillation. 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