Catheter ablation for atrial fibrillation: current patient selection and outcomes

ABSTRACT

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Ablation is an excellent treatment option for appropriately selected patients. Catheter ablation tools and techniques have evolved since AF ablation was first introduced, but pulmonary vein isolation remains the cornerstone of the procedure. Outcomes from ablation have improved dramatically over the last 20 years, but remain less than optimal for certain patient groups.

Areas covered: This review outlines the process of patient selection for AF ablation in contemporary practice, from diagnosis and AF classification to procedural risk assessment. Current guideline indications for AF ablation are reviewed. We discuss current reported outcomes from AF ablation and predictors for arrhythmia recurrence after ablation. The evolution of AF ablation technology and change in patient selection patterns are also discussed.

Expert commentary: AF ablation is an attractive alternative to antiarrhythmic drug therapy for many patients. Patient selection for ablation is an important part of management. Careful patient selection requires thorough, individualized clinical assessment based on symptoms, alternative treatment options, an estimation of procedural risk, and predicted recurrence rate to allow the patient to participate in shared decision-making.

KEYWORDS:

• Ablation
• atrial fibrillation

Declaration of interest

FE Marchlinski indicates that he has served as consultant and received lecture honorarium from Biosense Webster, Abbot-St Jude Medical, and Medtronic, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was supported by the Richard T and Angela Clark Innovation Fund in Cardiac Electrophysiology.