[From treating to curing--new era in the approach to patients with atrial fibrillation]

Abstract

Atrial fibrillation is the most common arrhythmia and its incidence and prevalence are growing steadily. It causes increased morbidity and mortality, while keeping patients in sinus rhythm was proven to decrease mortality rate. Nevertheless, antiarrhythmic drugs are limited in efficacy and have life-threatening adverse effects, thus neutralizing their benefits. Over the last years, ablation of pulmonary vein antrum has proven to be efficient in treating patients with atrial fibrillation. It has a success rate of 60-93% and overall complication rate of 6%. Recently, new ablation technologies entered the market and there has been improved understanding of the pathogenesis of atrial fibrillation. These improvements have led to better results and lower complication rates for atrial fibrillation ablation as a treatment option. In addition, new data was published regarding ablation treatment in the relatively healthy" elderly population. In the recent European Society of Cardiology (ESC) guidelines, ablation treatment for atrial fibrillation was graded as Class IA for patients who failed one antiarrhythmic drug and as Class IIA for patients who preferred ablation as their first treatment option. The field of atrial fibrillation ablation is evolving rapidly. The novel ablation catheters (the circular ones: PVAC and nMARQ, and the CryoCath balloon catheter) provide better tools for treating atrial fibrillation by reducing procedure time, making it possible to avoid general anesthesia and they are safer for use even in low-volume centers. These developments may enlarge the population that could be treated with ablation. It seems that we are in the middle of a process of change in the concept of treating atrial fibrillation.