Technical advances in the ablation of atrial fibrillation

There is now a general consensus that for patients with paroxysmal atrial fibrillation, the goal of a catheter ablation procedure should be electrical isolation of the pulmonary veins (PVs). Attaining acute PV isolation has been facilitated by the advent of electronatomic mapping systems that allow real-time 3-D reconstructions of cardiac chamber anatomy, as well as integration of pre-acquired CT/MR cardiac imaging. Nevertheless, chronic PV isolation continues to remain an elusive goal. This article reviews the development of imaging and balloon technologies that may bring the field closer to permanent PV isolation with a single procedure. Particularly with regard to persistent and long-standing persistent AF, this article also reflects on the use of robotic and linear ablation technologies to facilitate ablation of the atrial "substrate".