Effectiveness of catheter ablation of atrial fibrillationThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

This editorial refers to ‘Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized controlled study (Catheter Ablation for the Cure of Atrial Fibrillation Study)’† by G. Stabile et al., on page 216 Catheter ablation of atrial fibrillation (AF) has become increasingly popular in multiple centres worldwide as more studies have reported favourable success rates in preventing AF recurrences using various ablation techniques.1 Different strategies for ablating AF range from physiological approaches aimed at electrical segmental pulmonary vein (PV) isolation2,3 to anatomical circumferential PV ablation with or without the addition of linear ablation lines in the posterior left atrium and in the mitral isthmus.4,5 Recent randomized studies comparing these approaches have yielded conflicting results concerning the relative merits of segmental PV isolation vs. circumferential PV ablation.5,6 Despite numerous studies reporting results of different ablation techniques and more recent studies randomizing different techniques, surprisingly little data have been published comparing ablative therapy with medical therapy for AF. Catheter ablation of AF has been associated with major complications in 6% of patients;1 these include complications of vascular access, cardiac tamponade, stroke, PV stenosis, and rare but potentially fatal atrio-oesophageal fistulae. Given the risk of complications associated with AF ablation, randomized studies comparing ablation with medical therapy are necessary to guide physicians and patients in selecting optimal management strategies under different circumstances.