Catheter ablation therapy for atrial fibrillation

Catheter ablation therapy for the treatment of atrial fibrillation (AF) has evolved considerably in the past decade. Although the therapy was initially limited to ablation of the atrioventricular node to ensure adequate rate control for patients with rapid AF, the possibility of catheter-based rhythm control has now been demonstrated in several studies. Atrial extrasystoles originating from the pulmonary veins are now known to be triggers for the initiation of AF. Consequently, attempts at ablation have focused on the ablation of these triggers or on electrical isolation of these veins using radiofrequency ablation. More recently, three-dimensional electroanatomical imaging techniques have allowed for the development of left atrial ablation techniques, whereby long, linear lesions are created around the pulmonary venous ostia. Both of these techniques have shown interesting success rates in the treatment of symptomatic paroxysmal AF. The present article reviews the evolution of these techniques and lists the recommendations for the use of catheter ablation for both rate and rhythm control of AF.