Atrial fibrillation: unanswered questions and future directions

Just more than a decade ago, Haissaguerre and colleagues provided the seminal demonstration of the role of pulmonary vein triggers in the pathogenesis of atrial fibrillation (AF) and the potential therapeutic role of catheter ablation to treat patients who have paroxysmal AF. This initial observation ushered in the modern era of catheter ablation to treat patients who have AF, and tremendous progress has been made in understanding its pathogenesis and the catheter approaches to treating this rhythm. Although the current state of AF catheter ablation is well described earlier in this issue, this article reflects on some of the major unanswered questions about AF management, and the future technological and investigational directions being explored in the nonpharmacologic management of AF.