REVIEW Clinical update Catheter ablation of atrial fibrillation: an update

Catheter ablation of atrial fibrillation (AF) is nowan important therapeuticmodality for patientswithAF. There is considerable evidence available fromseveral prospective randomized trials demonstrating that catheter ablationofAF is superior to antiarrhythmicdrug therapy in controllingAF and that AF ablation improves quality of life substantially. This is especially true for patients with paroxysmal AFwithout other severe comorbid-ities. Catheter ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts at class 1 or 3 antiarrhythmic drug therapy have failed. Although current guidelines state that is appropriate to perform catheter ablation as a first-line therapy in selected patients, in our clinical practice this is rare. This reflects a number of important realities concerning the field of AF ablation. Catheter ablation of AF is a challenging and complex procedure, which is not free of the risk of potentially life-threatening complications, such as an atrio-oesophageal fistula, stroke, and cardiac tamponade. Although thesemajor complications are rare and their rate is falling, theymust be considered by both patients and physicians. The progressmade and the newdevelopments on the horizon in the field of AF catheter ablation are remarkable. When radiofrequency catheter ablation was first introduced in the late 1980s, few would have predicted that catheter ablation of AF would emerge as the most commonly performed ablation procedure in most major hospitals