Long-Term Results of Atrial Fibrillation Ablation

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, affecting about 0.4% of the general population. Its prevalence increases with age reaching 15% in adults over 70 years of age. During the past decade, as techniques and technologies have improved, catheter ablation of AF has become a standard and effective therapy for patients with symptomatic and drug-refractory AF. The improved three-dimensional electroanatomic mapping systems and the induction in the clinical practice of other ablation techniques, such as cryoablation, have contributed to the worldwide increase of the number of ablation procedures. Catheter ablation seems to be superior to antiarrhythmic drug therapy (ADT) which is also associated with potential toxic or proarrhythmic effects after long term use. The recently presented data from RAAFT 2 study, showed that 55% of the patients who had randomized to AF ablation had had a recurrence compared to 72%, of those who had received ADT after 2 years follow up. For the first time, the 2012 updated guidelines from the European Society of Cardiology, recommend catheter ablation as the first line therapy in selected patients with paroxysmal AF alternative to ADT (class IIa, level B). The main target of the AF catheter ablation is the circumferential electrical isolation of the pulmonary veins (PVs) ostium or antrum. In some patients suffering from persistent AF, a more aggressive strategy is adopted, including left atrial substrate modification with linear ablation or rarely with lesions in other anatomical structures as right atrium, superior or inferior vena cava, fossa ovalis, left atrial appendage and coronary sinus or the ligament of Marshall... (excerpt)