Catheter Ablation of Atrial Fibrillation - State of the Art

Atrial fibrillation (AF) is an arrhythmia associated with increased morbidity and mortality. Since the first report of catheter ablation curing AF, numerous techniques have evolved, from linear ablation to segmental pulmonary vein (PV) isolation, to extensive encircling PV isolation, to left atrial (LA) linear ablation, to ablation of complex fragmented atrial electrograms (CFAEs) and ablation of ganglionated plexi. A new approach for complete isolation of the posterior LA, including all PVs, is box isolation. PV isolation is associated with a high clinical success rate in paroxysmal AF. However, in persistent AF or longstanding persistent AF, PV isolation only may not be sufficient, so additional ablation at sites with CFAEs is needed to improve the clinical outcome. A hybrid approach of combining PV isolation plus CFAE ablation is highly effective in the majority of patients with persistent AF or longstanding persistent AF. Thus, AF ablation is an effective and established treatment for AF that offers an excellent chance of a lasting cure. It is about time that AF ablalion became a first-line therapy for selected patients with AF. (Circ J 2011; 75: 2305-2311)