Atrial Fibrillation Ablation Technique: State of the Art

Abstract

The role of the pulmonary veins in the initiation of atrial fibrillation has clearly been elucidated and has led to catheter ablation of atrial fibrillation (AF) via pulmonary vein isolation, currently achieved with use of radiofrequency energy. The 2011 American guideline update on the management of AF considers catheter ablation as a Class Ia indication in patients without significant structural heart disease refractory to antiarrhythmic drug therapy. The 2011 update on the guidelines for the management of AF by the European Society of Cardiology lists catheter ablation as a class IIa recommendation in patients refractory to antiarrhythmic drug therapy. Catheter ablation may be considered first-line therapy in a select group of patients with paroxysmal AF and no significant underlying structural heart disease if an experienced operator performs the procedure (class IIb indication). It should be kept in mind that the single-procedure success rate is low, with only 40%, 37% and 29% of patients remaining free from recurrent arrhythmias at 1, 2 and 5 years of follow-up, respectively; the success rates increase after two procedures to 87%, 81% and 63% at 1, 2 and 5 years. Patients with longstanding persistent AF have lower success rates compared with patients with paroxysmal or persistent AF. This article focuses on recent developments and new technologies currently under investigation.