Approaches to Catheter Ablation of Nonparoxysmal Atrial Fibrillation

We describe the technical aspects and outcomes of several different ablation strategies for nonparoxysmal (persistent and long-standing persistent) atrial fibrillation (AF) and discuss our ablation strategy for these patients.

Catheter ablation is an effective treatment strategy for patients with AF. Outcomes of ablation in patients with nonparoxysmal forms of AF tend to be worse than in patients with paroxysmal AF. Several recent studies have examined the long-term ablation success rates of different ablation approaches in patients with nonparoxysmal AF. While observational studies have suggested benefit of several different ablation strategies for persistent AF, large randomized controlled studies have shown similar success rates with pulmonary vein isolation (PVI) alone as compared versus PVI plus additional ablation. The optimal ablation strategy to achieve long-term freedom from recurrent arrhythmias in patients with nonparoxysmal AF remains controversial. Achieving durable PVI should be the cornerstone of AF ablation. Additional large-scale randomized controlled studies are necessary to determine whether additional ablation might result in improved long-term ablation success rates in these patients.