Catheter Ablation of Atrial Fibrillation: Where Are We?

Atrial fibrillation (AF) is the commonest cardiac arrhythmia, with significant morbidity and mortality. More than half of patients with AF are still symptomatic despite adequate anticoagulation and rate control. If antiarrhythmic drugs are ineffective or poorly tolerated, AF patients are then typically treated with catheter ablation to restore sinus rhythm. In the past 20 years, AF ablation has developed from a specialized, experimental procedure into a common treatment in the cardiovascular field. Various ablation techniques and mapping technologies have been described and are continuing to evolve for increased safety and efficacy. An incomplete list of such techniques and technologies would include focal and segmental, circumferential and linear, complex fractionated atrial electrogram, ganglionated plexus, focal impulse and rotor modulation, body surface potential mapping–guided, real-time MRI–guided, cryoballoon, visually guided laser balloon, radiofrequency hot balloon, contact force sensing catheter, multielectrode catheter, and hybrid ablations. This review examines the history of invasive AF treatment and its evolution into catheter ablation but mainly focuses on the discussion of various ablation techniques and technologies leading to our current understanding of the ablation therapy of this most common arrhythmia.