Ablation of atrial fibrillation: patient selection, technique, and outcome

Ablation of atrial fibrillation (AF) has expanded from its limited application for patients with paroxysmal AF and structurally normal hearts to patients with persistent arrhythmia and more extensive structural heart disease. The cornerstone of this procedure involves pulmonary vein (PV) isolation, which is achieved by encircling lesions around the PVs. Success rates are highest for patients with paroxysmal AF, but modification of the technique to include linear lesions in the left atrium and targeting complex electrograms has improved outcomes in patients with long-lasting AF. The procedure remains complex, and the risk of complications must be balanced against the perceived benefit of maintaining sinus rhythm. For this reason, AF ablation is indicated in symptomatic patients who have failed at least one antiarrhythmic drug. Current studies will address catheter ablation's role as first-line therapy for patients with AF.