Catheter ablation of atrial fibrillation: An update

Abstract

Catheter ablation of atrial fibrillation (AF) isnow animportant therapeutic modality for patients with AF. Thereis considerable evidence available from several prospective randomized trials demonstrating that catheter ablation of AF issuperiorto antiarrhythmic drug therapyincontrolling AF and that AF ablation improves quality of life substantially. This is especially true for patients with paroxysmal AF without other severe comorbidities. Catheter ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts at class 1 or 3 antiarrhythmic drug therapy have failed. Although current guidelines state that is appropriate to perform catheter ablation as a first-line therapy in selected patients, in our clinical practice this is rare. This reflects a number of important realities concerning the field of AF ablation. Catheter ablation of AF is a challenging and complex procedure, which is not free of the risk of potentially life-threatening complications, such as an atriooesophageal fistula, stroke, and cardiac tamponade. Although these major complications are rare and their rate is falling, they must be considered by both patients and physicians. The progress made and the new developmentsonthe horizon in the field of AF catheter ablation are remarkable. When radiofrequency catheter ablation was first introduced in the late 1980s, few would have predicted that catheter ablation of AF would emerge as the most commonly performed ablation procedure in most major hospitals.