[Atrial fibrillation ablation in the real world]

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and is associated with significant morbidity and mortality. Medical treatment often fails to control symptoms and the limited success of drug therapy has incited clinical investigators to explore alternative treatments. Demonstration of focal pulmonary vein activity initiating AF in 1998 heralded a new era of "curative" AF ablation. Over the last years this strategy has been adopted in one form or another by the electrophysiologists worldwide and progressively applied to patients with structural heart disease as well as those with persistent and long-lasting AF. Catheter ablation for AF does not come without risk. Complications have been described in individual center experiences and have recently been summarized in the worldwide survey of AF, with the purpose to provide a survey on the methods, safety, and efficacy of curative catheter ablation of AF over a broader spectrum of electrophysiology laboratories. The encouraging results of AF ablation reported by highly specialized centers in selected subsets of patients are undisputed but long-term prospective randomized studies are warranted to better define the patient population that may derive the greatest benefit from ablation at the lowest risk and at an acceptable cost.