[Atrial fibrillation ablation in the real world: the less we know, the more we ablate?]

Catheter ablation is now well established as an alternative or complementary therapeutic approach to the use of anti-arrhythmic drugs in selected patients with atrial fibrillation. Although pulmonary vein isolation is very effective in patients with paroxysmal atrial fibrillation, it is still not possible to identify the arrhythmogenic substrate responsible for fibrillation in a large number of patients, principally those with persistent atrial fibrillation. As a result, anatomic areas in the atrium that are not involved in either the initiation or maintenance of atrial fibrillation may undergo ablation. Until we have a better understanding of the pathophysiology of the different stages of atrial fibrillation, it would be wise to treat arrhythmias early, before anatomic or electrical deterioration of the atrium occurs.