[Catheter ablation of persistent atrial fibrillation : Current state]

The invasive treatment of persistent atrial fibrillation (AF) is one of the biggest challenges in modern electrophysiology. Treatment strategies are diverse and include pulmonary vein isolation (PVI) alone, left atrial ablation lines, local electrogram-based ablation of complex fractionated electrograms (CFAE) or various combinations of these techniques. New approaches comprise fibrosis-guided ablation or the localisation and ablation of AF sustaining rotors. Different ablation techniques reflect a different understanding of what the most important pathophysiological mechanism of persistent AF might be. Multiple wavelets, repetitive focal discharges (mostly from the pulmonary veins), instable micro-reentries, anatomically fixed slow conduction zones close to atrial scarring or (relatively stable) rotors have been proposed as AF sustaining factors. It has become evident that conventional ablation strategies often involve more than one ablation procedure to reach acceptable success rates, whereas new methods of fibrosis-guided ablation and rotor ablation are still under evaluation.