Catheter ablation has evolved to an established therapy for patients with symptomatic atrial fibrillation (AF). Complete pulmonary vein isolation currently is the best endpoint for catheter ablation. This can be achieved with balloon-based cryoablation as well as by point-by-point radiofrequency ablation supported by non-fluoroscopic mapping technologies—both technologies seem equally effective. AF catheter ablation is indicated in patients with symptomatic AF usually after failure of antiarrhythmic drug therapy. Selected patients with AF and tachycardia-induced heart failure may benefit from ablation by a significant improvement of left ventricular ejection fraction. The success rate (i.e. freedom from AF and atrial tachycardia) after a single procedure is approximately 50–60% for patients with paroxysmal AF and 40% for patients with persistent AF. With multiple procedures, freedom from AF can be achieved in up to 80% of patients with paroxysmal AF and 60% of patients with persistent AF. When performed after failed rhythm control attempts with antiarrhythmic drugs, catheter ablation is superior to a further attempt with antiarrhythmic drug medication. When applied as first-line therapy, catheter ablation tends to be slightly superior to first-line antiarrhythmic drug treatment. The complication rate of AF catheter ablation is 5–7%; severe complications occur in 2–3% (cardiac tamponade, periprocedural stroke, atrio-oesophageal fistula). Catheter ablation significantly improves quality of life but has no proven effect on mortality and/or stroke. Thus, in general, oral anticoagulation should be continued long term even if ablation is considered successful.
Editorial to “Improvement in quality of life and cardiac function after catheter ablation for asymptomatic persistent atrial fibrillation”
