Developments and recent advances in catheter ablation of paroxysmal atrial fibrillation

The development of catheter ablation for paroxysmal atrial fibrillation (AF) has evolved rapidly over the last 10 years from an experimental unproven procedure to a commonly performed ablation therapy in many major hospitals. The pulmonary vein (PV) and left atrium were discovered to be critical in the initiation and perpetuation of AF. With a better understanding of the AF mechanisms and more experience from the ablation follow-up, we have seen the ablation technique change from PV focal ablation to empirical circumferential isolation of all four PVs. In addition, the technological aid obtained from 3D electroanatomic mapping systems has further improved the safety and long-term efficacy and minimized the procedural difficulty. Recently, the atrial substrate analysis of the high-frequency and fractionated electrograms has further afforded the improvement in the outcome of more complex arrhythmias. Therefore, in this article, we will review the recent evidence and advancements in the mechanisms of AF and catheter ablation, and highlight the unsolved issues regarding future perspectives for paroxysmal AF.