Treatment of Atrial Fibrillation: Role of Catheter Ablation

Atrial fibrillation is the most common arrhythmia in the general population. It is associated with an increased morbidity and mortality. Current treatment strategies aim at either rate control or rhythm control. While antiarrhythmic drugs are insufficiently efficacious in maintaining sinus rhythm, catheter ablation of atrial fibrillation has emerged as an established, potentially curative treatment option with considerable success rates. Although there is still dissent concerning lesion concepts and procedural endpoints, circumferential pulmonary vein isolation forms the cornerstone of the ablation procedure in the majority of centres. Current guidelines recommend catheter ablation as second-line therapy for the treatment of atrial fibrillation. Accordingly, it is subjected to a well defined patient population with symptomatic, drug-refractory atrial fibrillation and without substantial comorbidities. However, there is growing evidence that catheter ablation is also beneficial in other patient subgroups without standard indication for ablation, e.g. heart failure patients and asymptomatic patients with tachycardia-related cardiomyopathy. In experienced centres, catheter ablation of atrial fibrillation is an efficacious and safe treatment option that might evolve into a first-line treatment strategy for selected patients taking into account the results of recently published studies.