Ablation therapy for atrial fibrillation (AF): past, present and future

Atrial fibrillation, the most common arrhythmia, is frequently disabling and drug resistant. Non-pharmacological approaches including surgery and catheter-based ablation have been developed for the most symptomatic patients. These new treatment strategies have dramatically increased our knowledge of the pathophysiology of this arrhythmia but most importantly demonstrated that atrial fibrillation is curable. These approaches are far from being perfect but good enough to be offered in routine practice to selected patients in experienced centers. The importance of pulmonary veins in the initiation of AF has clearly been demonstrated and their role in maintaining AF is likely. Most of the curative approaches are therefore based on their isolation. Future technical improvements based on presently applied concepts are likely to widen the indications for ablation therapy of AF.