Who should (or should not) be considered for catheter ablation of atrial fibrillation?

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. In addition to reductions in quality of life, functional status, and cardiac performance, AF is associated with an increased risk of stroke and overall mortality. The present-day management of AF is centred on improving arrhythmia-related symptoms, exercise tolerance, and quality of life, and reducing the morbidity and mortality associated with AF. For highly symptomatic patients catheter ablation has emerged as an important nonpharmacological treatment option. The purpose of this article is to discuss the contemporary role of AF ablation within the spectrum of care of patients afflicted with AF, with a focus on the practical aspects of determining who could benefit from this ever-evolving intervention through the examination of 4 illustrative cases.