Catheter ablation of longstanding persistent atrial fibrillation. Are we on the right path?

A number of different ablation strategies for persistent atrial fibrillation (PeAF) have been used, including pulmonary vein isolation (PVI), targeting of complex fractionated atrial electrograms (CFAEs), multilinear lesions and various combinations and modifications of these lesion sets. The optimal ablation strategy for longstanding PeAF (LPeAF) is not yet established and there is still much that is understood. Extensive atrial remodeling poses a particular challenge for the ablation of LPeAF. Current catheter ablation techniques used in the therapy of PeAF and LPeAF are reviewed, together with the electrophysiological basis of catheter ablation.