Atrial Fibrillation Ablation: Reaching the Mainstream

John D. Fisher; Michael A. Spinelli; Disha Mookherjee; Andrew K. Krumerman; Eugen C. Palma

Disclosures

Pacing Clin Electrophysiol. 2006;29(5):523-537. 

In This Article

Abstract and Introduction

Introduction and Aims: Ablation of atrial fibrillation (AF) has evolved rapidly in the decade since its inception. We aimed to review the results of this evolution as reflected in the published literature.
Methods: Publications through 2005 were reviewed, and data included if there was information on the technique used, and follow-up of at least 6 months.
Results: More than 23,000 patients met criteria for inclusion. There has been a steady improvement in reported outcomes (P < 0.001). Variations on radiofrequency catheter ablation for pulmonary vein isolation result in apparent elimination ("cure") or improvement of AF in 75%, and surgical techniques are even better.
Conclusions: Catheter ablation of AF is now a mainstream procedure. Continuing technical advances are needed to achieve better results with more uniformity and reduced procedure times.

Recent large trials have shown that for overall groups of patients with atrial fibrillation (AF), the strategy of establishing rate control during continuing AF is just as beneficial as "rhythm control" measures designed to restore and maintain sinus rhythm or a paced atrial rhythm (AFFIRM,[1] RACE[2]). Nevertheless, some individual patients do not tolerate AF well, and there is a widespread feeling that rhythm control would be preferable if it could be achieved without the use of toxic medications. Hence there is great interest in ablation for AF.

The relatively easy and effective techniques for curative ablation of atrioventricular nodal reentrant tachycardia and tachycardias related to accessory pathways are now well established. In contrast, approaches to ablation of AF remain in evolution, and new technologies and approaches continue to be developed. This commentary presents a perspective on the status of AF ablation based on over 23,000 procedures derived from the literature of the last several years.

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