![]() Thus, novel guidelines also address the important issue of AF ablation as a first-line strategy in patients with symptomatic PAF or persistent AF, prior to or in conjunction with Class I or III antiarrhythmic drug therapy (Class IIa). Although invasive cardiac procedures involve the potential for life-threatening complications, long-term AAD therapy has been shown to be more commonly associated with considerable side effects compared to ablation (17 vs. Ĭatheter ablation of AF is recommended as a second-line therapy for patients with symptomatic paroxysmal AF (PAF) or persistent AF for whom therapy with antiarrhythmic drugs (AADs) (Class I) has failed and for patients with long-standing-persistent AF with a Class IIb indication. Current guidelines recommend that additional variables to be considered, including, among others, the presence of concomitant heart disease, obesity and sleep apnea, as these variables could result in a higher complication rate, as well as left atrial (LA) size, patient age and type of AF. Therefore, the primary selection criterion for AF ablation is the presence of symptoms, such as fatigue, palpitations and dyspnea. However, further studies are warranted to further improve our knowledge of the underlying mechanisms of AF and to obtain long-term clinical outcomes on new ablation techniques.Īs demonstrated in a variety of published studies, the primary clinical benefit of catheter ablation of AF is improvement in the quality of life. Patients with non-paroxysmal AF and with AF recurrence might benefit from alternative ablation strategies. Novel ablation tools, such as balloon technologies or alternative energy sources, might help to overcome this limitation. The reconnection of previously isolated pulmonary veins remains the major cause of AF recurrence. Pulmonary vein isolation is the treatment of choice for symptomatic patients with paroxysmal and persistent drug-refractory AF. New technologies and techniques, such as identification of the AF sources and magnetic resonance imaging-guided substrate modification, are on the way to further improve the success rates of catheter ablation for selected patients and might help to further reduce arrhythmia recurrence. Patients with persistent or long-standing persistent AF and with arrhythmia recurrence after previous PVI may benefit from additional ablation strategies, such as substrate modification of various forms or left atrial appendage isolation. While radiofrequency-based PVI in conjunction with a three-dimensional mapping system was for many years considered to be the “gold standard”, the cryoballoon has emerged as the most commonly used alternative AF ablation tool, especially in patients with paroxysmal AF. Antral pulmonary vein isolation (PVI) as a stand-alone ablation strategy results in beneficial clinical outcomes and is therefore recommended as first-line strategy for both paroxysmal and persistent AF. Recent FindingsĬatheter ablation is a well-established treatment option for patients with symptomatic AF and is more successful at maintaining SR than antiarrhythmic drugs. In this review, we summarize the current state of the art of catheter ablation of AF and describe future perspectives. A variety of energy sources and devices have been developed and evaluated. Maintenance of stable sinus rhythm (SR) is the intended treatment target in symptomatic patients, and catheter ablation aimed at isolating the pulmonary veins provides the most effective treatment option, supported by encouraging clinical outcome data. Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with high rates of morbidity and mortality.
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