Atrial fibrillation (Part 2)-catheter ablation

Abstract

More than 20 years since its initial use, catheter ablation has become a routinely performed procedure for the treatment of patients with atrial fibrillation (AF). Initially based on the electrical isolation of pulmonary veins in patients with paroxysmal AF, subsequent advances in the understanding of pathophysiology led to additional techniques not only to achieve better results, but also to treat patients with persistent forms of arrhythmia, as well as patients with structural heart disease and heart failure. Significant technological advances, especially in 3D electroanatomic mapping, intracardiac echocardiography use and how energy is delivered to the tissue (cryoablation and tissue contact force with radiofrequency) have allowed a significant reduction in the rate of complications and in the use of ionizing radiation. Currently, ablation is the most efficient treatment for patients with AF, and an excellent alternative to the use of antiarrhythmic drugs, whose development has been insignificant in recent decades. With the pioneering observations made by Haissaguerre et al.,1 the pivotal role of arrhythmogenic foci located in the pulmonary veins (PV) in the pathophysiology of the initiation and maintenance of AF episodes was shown. The concept of focal AF was then established, where atrial arrhythmia that diffusely affects both atria have a well-determined origin, and is therefore susceptible to therapeutic interventions. Techniques using catheter ablation were developed and improved to eliminate AF-generating foci through circumferential ablation around the PVs,2-4 with higher success and performance rates compared to the best pharmacological therapy.5-10 The aim of this article is to review the advances in catheter ablation for AF and describe to the clinical cardiologist state-of-the-art indications, techniques, results and complications.