Catheter Ablation of Atrial Fibrillation

Atiarrhythmic drugs that are currently in use are not only frequently ineffective at eliminating atrial fibrillation (AF), but also life-threatening in some patients. However, the accumulating clinical experience along with the remarkable advancement in the technology has made the catheter ablation (CA) of AF more effective and safe. The application of circular mapping catheters that can identify pulmonary vein (PV) potentials (PVPs) within the PVs has allowed the effective guidance of the electrical isolation of the PVs from the left atrium (LA). The widespread utilization of 3-dimensional (D) mapping systems has facilitated the improvement of the outcomes after CA in patients with paroxysmal (PAF) and even chronic AF (CAF). Different strategies that are currently in use are as follows segmental ablation of each PV ostium guided by PVPs, pure anatomic approach of circumferential PV ablation (CPVA), CPVA with electrical isolation, complex fractionated atrial electrograms during AF guided ablation, and ablation of ganglionated plexuses, etc. The efficacy of each approach varies according to the investigators and subsets of AF. CPVA with electrical isolation is known to be more effective and is widely used. With further development of new energy sources of ablation and mapping systems, it is important to simplify, standardize, and shorten the procedures, which may enable the CA to become more effective, safe, and applicable to many different subsets of AF. CA of AF has evolved rapidly and has become accepted as one of the therapeutic modalities to cure AF.