Epicardial catheter ablation of atrial fibrillation

Catheter ablation for atrial fibrillation, while superior to medical therapy alone, carries significant risk of complications and limited efficacy. Surgical therapy for atrial fibrillation, including the maze procedure, seems to be more effective but is also more invasive than percutaneous approaches. In this review, we outline the rationale for a percutaneous catheter-based epicardial ablation strategy. Operators considering such a procedure should have a detailed understanding of the anatomy of the pericardial space, which is reviewed in this manuscript. Also, technology used in epicardial ablation and special challenges of epicardial ablation are discussed. Finally, some preliminary work on epicardial ablation of atrial fibrillation is reviewed before concluding with some possibilities for future research in the area.