Ablation of atrial fibrillation

Abstract

Associated with significant morbidity and mortality, atrial fibrillation is one of the most common cardiac rhythm disorders. Cure of this arrhythmia has been elusive over the years, despite development of different antiarrhythmic drugs and advances in the understanding of its pathophysiology. Initial experience with catheter ablation procedures based on the creation of linear lesions in both atria has been disappointing, but has led to the key observation that focal triggers localized in the pulmonary veins are responsible for initiation of atrial fibrillation, and thus are suitable targets for catheter ablation. With advances in technology and larger experience, it has become clear that electrical isolation of all four pulmonary veins from the left atrium provides the higher cure rates. However, the procedure is still operator dependent and is associated with a small but significant risk of pulmonary vein stenosis. Further simplification of the isolation techniques and refinement in the catheter design will allow more widespread use of this procedure and higher success rate.