1Chapter 12 • Atrial Fibrillation Ablation Executive Summary

Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and is a rapidly growing epidemic. Catheter ablation for AF is possible because atrial fibrillation is frequently incited by focal triggers, many of which arise from the pulmonary veins. Current ablation techniques seek to eliminate or isolate these triggers from the rest of the atria in order to restore sinus rhythm. The mainstay of ablation remains radio frequency energy, although other energy sources are currently under investigation. Accurate imaging and mapping is important for successful AF ablation. The combination of intracardiac echo, computed tomography (CT), and magnetic resonance (MR) imaging with a three-dimensional electroanatomical mapping system is useful to prepare and perform these procedures. In addition, post-ablation CT or MR imaging can identify pulmonary vein stenosis or atrio-esophageal fistula. The remote catheter navigation technology promises to reduce risk to the patient and radiation exposure to the physician. Significant advances in catheter ablation for AF will lead to safer procedures and better outcomes. More rigorous randomized trials and long-term follow-up are needed to further define the role of catheter ablation in the management of atrial fibrillation