Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov 21;11(22):6871.
doi: 10.3390/jcm11226871.

Evolving Role of Catheter Ablation for Atrial Fibrillation: Early and Effective Rhythm Control

Shaojie Chen  1   2   3 , Yuehui Yin  3 , Zhiyu Ling  3 , Christian Meyer  4   5   6   7 , Helmut Pürerfellner  8 , Martin Martinek  8 , Márcio Galindo Kiuchi  9 , Piotr Futyma  10 , Lin Zhu  11 , Alexandra Schratter  12 , Jiazhi Wang  13 , Willem-Jan Acou  14 , Philipp Sommer  15 , Feifan Ouyang  16 , Shaowen Liu  17 , Julian K R Chun  1   2 , Boris Schmidt  1
Affiliations
Review

Evolving Role of Catheter Ablation for Atrial Fibrillation: Early and Effective Rhythm Control

Shaojie Chen et al. J Clin Med. .

Abstract

Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, the time of Diagnosis-to-Intervention appears crucial. Recent evidence shows that earlier rhythm control is associated with a lower risk of adverse cardiovascular outcomes in patients with early AF. Particularly, CA as an initial first line rhythm control strategy is associated with significant reduction of arrhythmia recurrence and rehospitalization in patients with paroxysmal AF. CA is shown to significantly lower the risk of progression from paroxysmal AF to persistent AF. When treating persistent AF, the overall clinical success after ablation remains unsatisfactory, however the ablation outcome in patients with "early" persistent AF appears better than those with "late" persistent AF. "Adjunctive" ablation on top of pulmonary vein isolation (PVI), e.g., ablation of atrial low voltage area, left atrial posterior wall, vein of Marshall, left atrial appendage, etc., may further reduce arrhythmia recurrence in selected patient group. New ablation concepts or new ablation technologies have been developing to optimize therapeutic effects or safety profile and may ultimately improve the clinical outcome.

Keywords: ablation; atrial fibrillation; rhythm control.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 4
Figure 4
Catheter Ablation of Persistent Atrial Fibrillation. (A) Catheter ablation in “early” persistent AF. (B) Catheter ablation in “late” persistent AF. (C) Catheter ablation in non-PV sites.
Figure 6
Figure 6
Catheter Ablation and Atrial Fibrillation Burden.
Figure 7
Figure 7
Ablation Concepts Additionally, Technologies For Improved Ablation Quality.
Figure 8
Figure 8
Graphic Summary Chen et al.
Figure 1
Figure 1
Progression of Atrial Fibrillation and Early Rhythm Control.
Figure 2
Figure 2
Catheter Ablation as Early Initial Therapy for Paroxysmal Atrial Fibrillation.
Figure 3
Figure 3
Effect of Catheter Ablation on Progression of AF Estimated from Publications.
Figure 5
Figure 5
Effect Of Catheter Ablation on Clinical “Hard” Endpoints.
See this image and copyright information in PMC

References

    1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C., Boriani G., Castella M., Dan G.-A., ESC Scientific Document Group et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS) Eur. Heart J. 2021;42:373–498. doi: 10.1093/eurheartj/ehaa612. - DOI - PubMed
    1. Chen S., Pürerfellner H., Meyer C., Sommer P., Kiuchi M.G., Martinek M., Futyma P., Zanchi S., Zhu L., Schratter A., et al. Anticoagulation in atrial fibrillation and liver disease: A pooled-analysis of >20000 patients. Eur. Heart J. Cardiovasc. Pharmacother. 2021;8:336–345. doi: 10.1093/ehjcvp/pvab032. - DOI - PubMed
    1. January C.T., Wann L.S., Calkins H., Chen L.Y., Cigarroa J.E., Cleveland J.C., Jr., Ellinor P.T., Ezekowitz M.D., Field M.E., Furie K.L., et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:104–132. doi: 10.1016/j.jacc.2019.01.011. - DOI - PubMed
    1. Kirchhof P., Camm A.J., Goette A., Brandes A., Eckardt L., Elvan A., Fetsch T., van Gelder I.C., Haase D., EAST-AFNET 4 Trial Investigators et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. New Engl. J. Med. 2020;383:1305–1316. doi: 10.1056/NEJMoa2019422. - DOI - PubMed
    1. Kuniss M., Pavlovic N., Velagic V., Hermida J.S., Healey S., Arena G., Badenco N., Meyer C., Chen J., Cryo-FIRST Investigators et al. Cryoballoon ablation vs. antiarrhythmic drugs: First-line therapy for patients with paroxysmal atrial fibrillation. Europace. 2021;23:1033–1041. doi: 10.1093/europace/euab029. - DOI - PMC - PubMed

LinkOut - more resources