[Catheter ablation for persistent atrial fibrillation: looking for the best strategy]

Drug-refractory atrial fibrillation (AF) can be highly symptomatic and warrant invasive ablation targeting the pulmonary veins. Although limited ablation for paroxysmal AF is associated with a high success rate, more extensive ablation appears to be indicated for persistent AF. The Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR AF II) showed that the addition of complex fractionated atrial electrogram (CFAE) ablation or linear ablation lesions did not result in an improved ablation outcome. However, novel techniques that allow assessment ]\of AF substrate, rotor mapping and AF trigger ablation have been associated with improved ablation outcome and randomised studies evaluating these techniques are currently being designed.