The techniques for catheter ablation of paroxysmal and persistent atrial fibrillation: a systematic review

PURPOSE OF REVIEW: Ablation for atrial fibrillation has become a widely accepted and practiced treatment for this arrhythmia. However, the technique for ablation has evolved over time, particularly for the two distinct groups of paroxysmal and persistent atrial fibrillation. This review outlines the optimal techniques for ablation of these different subgroups of atrial fibrillation. RECENT FINDINGS: The most commonly applied techniques for atrial fibrillation ablation include isolation of the pulmonary venous antra, left-atrial linear ablation, and ablation of complex fractionated electrograms (CFEs) during atrial fibrillation. For patients with paroxysmal atrial fibrillation, isolation of the pulmonary venous antra appears to be sufficient, with effective and reproducible outcomes being reported across many centers. For persistent atrial fibrillation, the outcome of catheter ablation is less efficacious. It is widely believed that additional ablation targeting the substrate of atrial fibrillation maintenance is required beyond pulmonary venous isolation. Linear and CFE ablation have been the most commonly employed adjuvant strategies employed, but neither has been adequately compared with the other to make definitive recommendations. SUMMARY: Pulmonary venous antral isolation is the cornerstone of ablation of both paroxysmal and persistent atrial fibrillation. However, to obtain better outcomes in persistent atrial fibrillation, further adjuvant ablation, in the form of either linear or CFE ablation, will likely have to be performed to achieve comparable success rates.