Catheter ablation for atrial fibrillation: indications and future perspective

Andrea Natale, Sanghamitra Mohanty, Prashanthan Sanders, Elad Anter, Ashok Shah, Ghaliah Al Mohani, Michael Haissaguerre

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Recent advances in techniques, technologies and proven superiority over anti-arrhythmic drugs have made catheter ablation the cornerstone of management for atrial fibrillation (AF), which has shown a steady increase in prevalence in the ageing population worldwide. The aim of therapeutic interventions is to achieve stable sinus rhythm that would improve the quality of life and reduce the risk of AF-associated complications. Pulmonary veins (PVs) were first described as the source of initiation of ectopic triggers driving AF, which led to the establishment of PV isolation (PVI) as the most widely practiced procedure to treat AF. Antral PVI is still recognized as the stand-alone ablation strategy for newly diagnosed paroxysmal AF (PAF). However, in non-PAF patients, PVI seems to be inadequate and several adjunctive strategies, including ablation of left atrial posterior wall and non-PV triggers, AF mapping and ablation of rotors and drivers, ethanol infusion of vein of Marshall and renal denervation, etc. have been reported with mixed results. Recent trials have also documented the benefits of early rhythm control in preventing cardiovascular events in addition to slowing the progression of PAF to more persistent forms. Similarly, very late relapse of the arrhythmia after successful PVI has drawn attention to the critical role of non-PV triggers and highlighted their relevance as potential ablation targets during repeat procedures. Ablation technology is also under constant evolution with the introduction of non-thermal energy sources and new tools to create durable lesions. This review summarizes the indications, advancements, and future perspective of AF ablation.

Original languageEnglish
Pages (from-to)4383-4398
Number of pages16
JournalEuropean heart journal
Volume45
Issue number41
DOIs
Publication statusPublished or Issued - 1 Nov 2024
Externally publishedYes

Keywords

  • AF Progression
  • Atrial fibrillation
  • Catheter ablation
  • Cognition
  • Pulsed-field ablation
  • Quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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