Current Cardiology Reports

, 13:394 | Cite as

Atrial Fibrillation: Update on Ablation Strategies and Technology



Catheter ablation has become an important and widely used treatment modality for patients with symptomatic atrial fibrillation. The superior efficacy of catheter ablation over antiarrhythmic therapy has been well established. The understanding of the pathophysiology of atrial fibrillation has led to the development of catheter-based ablation techniques. The development of techniques for catheter ablation of atrial fibrillation has rapidly progressed over the last 15 years. As our knowledge of this arrhythmia expands the strategies for ablation treatment continue to evolve. New technologies aim to improve the safety, efficacy, and speed of catheter ablation for atrial fibrillation.


Atrial fibrillation Catheter ablation Pulmonary vein 


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Naccarelli GV et al. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104(11):1534–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Van Gelder IC et al. RAte control efficacy in permanent atrial fibrillation: a comparison between lenient versus strict rate control in patients with and without heart failure. Background, aims, and design of RACE II. Am Heart J. 2006;152(3):420–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Wyse DG et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Issa ZF. Clinical arrhythmology and electrophysiology. 1st ed. Saunders Elevier; 2009.Google Scholar
  5. 5.
    Cox JL, Schuessler RB, Boineau JP. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg. 2000;12(1):2–14.PubMedGoogle Scholar
  6. 6.
    Cox JL et al. Current status of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg. 2000;12(1):15–9.PubMedGoogle Scholar
  7. 7.
    Khargi K et al. Surgical treatment of atrial fibrillation; a systematic review. Eur J Cardiothorac Surg. 2005;27(2):258–65.PubMedCrossRefGoogle Scholar
  8. 8.
    Haissaguerre M et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659–66.PubMedCrossRefGoogle Scholar
  9. 9.
    Lin WS et al. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation. 2003;107(25):3176–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Mansour M, Ruskin J, Keane D. Initiation of atrial fibrillation by ectopic beats originating from the ostium of the inferior vena cava. J Cardiovasc Electrophysiol. 2002;13(12):1292–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Tsai CF et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation. Circulation. 2000;102(1):67–74.PubMedGoogle Scholar
  12. 12.
    Hwang C et al. Vein of marshall cannulation for the analysis of electrical activity in patients with focal atrial fibrillation. Circulation. 2000;101(13):1503–5.PubMedGoogle Scholar
  13. 13.
    Chen PS et al. The mechanisms of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17 Suppl 3:S2–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Chen SA et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation. 1999;100(18):1879–86.PubMedGoogle Scholar
  15. 15.
    Chen YJ, Chen SA. Electrophysiology of pulmonary veins. J Cardiovasc Electrophysiol. 2006;17(2):220–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Oral H et al. Segmental ostial ablation to isolate the pulmonary veins during atrial fibrillation: feasibility and mechanistic insights. Circulation. 2002;106(10):1256–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Pappone C et al. Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation. Circulation. 2000;102(21):2619–28.PubMedGoogle Scholar
  18. 18.
    Mansour M, Ruskin J, Keane D. Efficacy and safety of segmental ostial versus circumferential extra-ostial pulmonary vein isolation for atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15(5):532–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Pappone C et al. Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach. Circulation. 2004;110(19):3036–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Wazni OM et al. Atrial fibrillation ablation in patients with therapeutic international normalized ratio: comparison of strategies of anticoagulation management in the periprocedural period. Circulation. 2007;116(22):2531–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Hussein AA et al. Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy. Hear Rhythm. 2009;6(10):1425–9.CrossRefGoogle Scholar
  22. 22.
    Abhishek F, et al. Effectiveness of a strategy to reduce major vascular complications from catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 30(3):211–5.Google Scholar
  23. 23.
    Ernst S et al. Catheter-induced linear lesions in the left atrium in patients with atrial fibrillation: an electroanatomic study. J Am Coll Cardiol. 2003;42(7):1271–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Willems S et al. Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison. Eur Heart J. 2006;27(23):2871–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Elayi CS et al. Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies. Hear Rhythm. 2008;5(12):1658–64.CrossRefGoogle Scholar
  26. 26.
    Nademanee K et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43(11):2044–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Takahashi Y et al. Characterization of electrograms associated with termination of chronic atrial fibrillation by catheter ablation. J Am Coll Cardiol. 2008;51(10):1003–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Mansour M, et al. Combined use of cryoballoon and focal open-irrigation radiofrequency ablation for treatment of persistent atrial fibrillation: results from a pilot study. Heart Rhythm. 7(4):452–8.Google Scholar
  29. 29.
    Singh SM, et al. Intraprocedural use of ibutilide to organize and guide ablation of complex fractionated atrial electrograms: preliminary assessment of a modified step-wise approach to ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 21(6):608–16. Google Scholar
  30. 30.
    Wilber DJ, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 303(4):333–40.Google Scholar
  31. 31.
    Takahashi Y et al. Sites of focal atrial activity characterized by endocardial mapping during atrial fibrillation. J Am Coll Cardiol. 2006;47(10):2005–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Cappato R et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111(9):1100–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Lustgarten DL, Keane D, Ruskin J. Cryothermal ablation: mechanism of tissue injury and current experience in the treatment of tachyarrhythmias. Prog Cardiovasc Dis. 1999;41(6):481–98.PubMedCrossRefGoogle Scholar
  34. 34.
    Friedman PL et al. Catheter cryoablation of supraventricular tachycardia: results of the multicenter prospective “frosty” trial. Hear Rhythm. 2004;1(2):129–38.CrossRefGoogle Scholar
  35. 35.
    Neumann T et al. Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. J Am Coll Cardiol. 2008;52(4):273–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Dukkipati SR, et al. Visual balloon-guided point-by-point ablation: reliable, reproducible, and persistent pulmonary vein isolation. Circ Arrhythm Electrophysiol. 3(3):266–73.Google Scholar
  37. 37.
    Schmidt B, et al. Feasibility of circumferential pulmonary vein isolation using a novel endoscopic ablation system. Circ Arrhythm Electrophysiol. 3(5):481–8.Google Scholar
  38. 38.
    • Perna F, Heist EK, Danik SB, et al. Assessment of catheter tip contact force resulting in cardiac perforation in Swine atria using force sensing technology. Circ Arrhythm Electrophysiol. 2011;4(2):218–24. This study describes the force at the tip of the ablation catheter that results in cardiac perforation.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Massachusetts General Hospital, Cardiac Arrhythmia ServiceBostonUSA

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