Catheter ablation of atrial fibrillation: Where do we stand now

Atrial fibrillation is the commonest arrhythmia. Besides the risk of compli cations, a significant number of patients remain symptomatic despite the di fferent antiarrhythmic drugs currently available. The only curative treatme nt is by surgery or catheter ablation. Since 1994, several approaches have been developed based on two main concep ts: modification of the arrhythmogenic substrate by linear lesion to preven t the perpetuation of the arrhythmia and ablation of the foci initiating th e atrial fibrillation. The later approach is the most popular one at the mo ment because the concentration of foci at the site of the pulmonary veins m akes it possible to isolate them relatively easily. The presence of atrial foci in some patients complicates matters and limits the success rate to 70 %. Despite these limitations and with an acceptable rate of complications, thi s approach appears preferable to His bundle ablation in young patients with symptomatic paroxysmal atrial fibrillation resistant to antiarrhythmic the rapy.