[HSF] afib theory

[Tea Acuff]

I spent the last week watching some endoscopic ablation for afib so afib was on my mind while I was doing some related (but not related to afib) reading.
 
We do various "lesions" for various "status" of afib for various presumptive etiologies. I use the word "lesions" because I am not sure we are really more precise than that. One of the things that I noticed by looking at schematics  of different lesions from surgical and catheter cases is that our mechanisms of treatment resemble the types of lesions that we (imagine) that we make. Are we really laying linear "blockers" for conduction, or are we ablating discrete foci or "ganglion" or sources, or both, or some yet unknown injury type(s)? 
 
Does anyone think that these two theories of ablative mechanism (linear ablation blockers or ablation of discrete ganglion) are more inherent or derivative in the pathology or the pathologist (ie us) and his ablative tools? Or is all therapy and diagnostic mechanism, even the pathology itself, relational? Is there a best or only options? (What about coronary disease? CHF with MR? The dilated aorta? Recurrent TR?) 
 
Just to mix up the question a little with other related (but not related to afib as yet) information, Ben has noted that some of our interventions are genomic related or genetically informed. We don't do precisely what we think we do based on just our most recent normative and authoritative studies. Our information or knowledge is not the last word in the interventional process. The "word" or genetic information in the system ante  our intervention or even our inspection has its say also, regardless of what we agree among ourselves that we are doing. Knowledge and that little applied detail, epistemology, are active every where we look. How do we know? How does the patient, his organs, and his cells know what to do with what we do? What we think that we do is, of course, linked with what we think that we see the patient do. The patient is subjected to this information: what we say to his mind, what we think about what we do and what we are able to do. 
 
tea