Skip to main content
Log in

Radiofrequency ablation for atrial fibrillation

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Catheter ablation has emerged as an excellent treatment option for atrial fibrillation. In appropriate patients, particularly those with paroxysmal atrial fibrillation in the absence of structural heart disease, catheter-based pulmonary vein isolation can eliminate or dramatically reduce the arrhythmia burden. However, with currently available tools, the procedure is complex and labor intensive. Simpler ablation procedures may emerge as newer ablation systems are developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Feinberg WM, Cornell ES, Nightingale SD, et al.: Relationship between prothrombin activation fragment F1.2 and international normalized ratio in patients with atrial fibrillation. Stroke Prevention in Atrial Fibrillation Investigators. Stroke 1997, 28:1101–1106.

    PubMed  CAS  Google Scholar 

  2. Go AS, Hylek EM, Phillips KA, et al.: Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001, 285:2370–2375.

    Article  PubMed  CAS  Google Scholar 

  3. Jais P, Haissaguerre M, Shah DC, et al.: A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997, 95:572–576.

    PubMed  CAS  Google Scholar 

  4. Haissaguerre M, Jais P, Shah DC, et al.: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998, 339:659–666. Landmark article describing the first clinical significance of pulmonary vein foci and their treatment with radiofrequency ablation.

    Article  PubMed  CAS  Google Scholar 

  5. Chen SA, Tai CT, Yu WC, et al.: Right atrial focal atrial fibrillation: electrophysiologic characteristics and radiofrequency catheter ablation. J Cardiovasc Electrophysiol 1999, 10:328–335.

    Article  PubMed  CAS  Google Scholar 

  6. Moe GK, Abildskov JA: Atrial fibrillation as a self sustaining arrhythmia independent of focal discharge. Am Heart J 1959, 58:59–70.

    Article  PubMed  CAS  Google Scholar 

  7. Fuster V, Ryden LE, Asinger RW, et al.: ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Circulation 2001, 104:2118–2150. Very comprehensive overview of all aspects of AF therapy representing the most recent guidelines of the three major cardiology societies.

    PubMed  CAS  Google Scholar 

  8. Wyse DG, AFFIRM Investigators: Survival in patients presenting with atrial fibrillation: the atrial fibrillation follow-up investigation of rhythm management (AFFIRM) Study. 51st Annual Scientific Session. Atlanta, GA: March 17–20, 2002.

  9. Cox JL, Schuessler RB, D’Agostino HJ Jr, et al.: The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991, 101:569–583.

    PubMed  CAS  Google Scholar 

  10. Swartz JF, Pellersels G, Silvers J, et al.: A catheter-based curative approach to atrial fibrillation in humans. Circulation 1994, 90(suppl):I-335.

    Google Scholar 

  11. Haissaguerre M, Jais P, Shah DC, Clementy J: Catheter ablation for atrial fibrillation: clinical electrophysiology of linear lesions. In Cardiac Electrophysiology. From Cell to Bedside, edn 3. Edited by Zipes DP, Jalife J. Philadelphia: W.B. Saunders Company; 2000:994–1008.

    Google Scholar 

  12. Haissaguerre M, Marcus FI, Fischer B, Clementy J: Radiofrequency catheter ablation in unusual mechanisms of atrial fibrillation: report of three cases. J Cardiovasc Electrophysiol 1994, 5:743–751.

    Article  PubMed  CAS  Google Scholar 

  13. Nathan H, Eliakim M: The junction between the left atrium and the pulmonary veins. An anatomic study of human hearts. Circulation 1966, 34:412–422.

    PubMed  CAS  Google Scholar 

  14. Chen SA, Hsieh MH, Tai CT, 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, 100:1879–1886.

    PubMed  CAS  Google Scholar 

  15. Tsai CF, Tai CT, Hsieh MH, et al.: Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation. Circulation 2000, 102:67–74.

    PubMed  CAS  Google Scholar 

  16. Gerstenfeld EP, Guerra P, Sparks PB, et al.: Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers. J Cardiovasc Electrophysiol 2001, 12:900–908.

    Article  PubMed  CAS  Google Scholar 

  17. HaissaguerreM, Jais P, Shah DC, et al.: Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000, 101:1409–1417. Outstanding article that defined the current state of the art technique of pulmonary vein isolation.

    PubMed  CAS  Google Scholar 

  18. Haissaguerre M, Shah DC, Jais P, et al.: Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000, 102:2463–2465.

    PubMed  CAS  Google Scholar 

  19. Wood MA, Kay GN, Ellenbogen KA: The North American experience with the Ablate and Pace Trial (APT) for medically refractory atrial fibrillation. Europace 1999, 1:22–25.

    Article  PubMed  CAS  Google Scholar 

  20. Ho SY, Sanchez-Quintana D, Cabrera JA, Anderson RH: Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 1999, 10:1525–1533.

    Article  PubMed  CAS  Google Scholar 

  21. Lickfett L, Kato R, Halperin H, et al.: Comprehensive and detailed analysis of pulmonary veins, left atrial appendage and their interrelations with gadolinium enhanced magnetic resonance angiography and 3 D navigation view analysis. 51st Annual Scientific Session. Atlanta, GA: March 17–20, 2002.

  22. Oral H, Knight BP, Tada H, et al.: Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002, 105:1077–1081.

    Article  PubMed  Google Scholar 

  23. Huang DT, Monahan KM, Zimetbaum P, et al.: Hybrid pharmacologic and ablative therapy: a novel and effective approach for the management of atrial fibrillation. J Cardiovasc Electrophysiol 1998, 9:462–469.

    Article  PubMed  CAS  Google Scholar 

  24. Tsao HM, Yu WC, Cheng HC, et al.: Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging. J Cardiovasc Electrophysiol 2001, 12:809–813.

    Article  PubMed  CAS  Google Scholar 

  25. Cooper JM, Epstein LM: Use of intracardiac echocardiography to guide ablation of atrial fibrillation. Circulation 2001, 104:3010–3013.

    PubMed  CAS  Google Scholar 

  26. Tse HF, Lee KL, Lau CP: Adenosine triphosphate enhanced contrast pulmonary venogram to facilitate pulmonary vein ablation. J Cardiovasc Electrophysiol 2002, 13:300.

    Article  PubMed  Google Scholar 

  27. Cosio FG, Lopez-Gil M, Goicolea A, et al.: Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993, 71:705–709.

    Article  PubMed  CAS  Google Scholar 

  28. Pappone C, Oreto G, Rosanio S, et al.: Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001, 104:2539–2544.

    PubMed  CAS  Google Scholar 

  29. Jais P, Shah DC, Haissaguerre M, et al.: Efficacy and safety of septal and left-atrial linear ablation for atrial fibrillation. Am J Cardiol 1999, 84:139R-146R.

    Article  PubMed  CAS  Google Scholar 

  30. Wilber D: Ablation of atrial fibrillation. Scientific Sessions 2001, American Heart Association. Anaheim, CA. November 11–14, 2001.

  31. Jumrussirikul P, Atiga WL, Lardo AC, et al.: Prospective comparison of lesions created using a multipolar microcatheter ablation system with those created using a pullback approach with standard radiofrequency ablation in the canine atrium. Pacing Clin Electrophysiol 2000, 23:203–213.

    Article  PubMed  CAS  Google Scholar 

  32. Natale A, Pisano E, Shewchik J, et al.: First human experience with pulmonary vein isolation using a throughthe-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation 2000, 102:1879–1882.

    PubMed  CAS  Google Scholar 

  33. Fried NM, Tsitlik A, Rent KC, et al.: Laser ablation of the pulmonary veins by using a fiberoptic balloon catheter: implications for treatment of paroxysmal atrial fibrillation. Lasers Surg Med 2001, 28:197–203.

    Article  PubMed  CAS  Google Scholar 

  34. Tanaka K, Satake S, Saito S, et al.: A new radiofrequency thermal balloon catheter for pulmonary vein isolation. J Am Coll Cardiol 2001, 38:2079–2086.

    Article  PubMed  CAS  Google Scholar 

  35. Lemery R, Veinot JP, Tang AS, et al.: Fiberoptic balloon catheter ablation of pulmonary vein ostia in pigs using photonic energy delivery with Diode laser. Pacing Clin Electrophysiol 2002, 25:32–36.

    Article  PubMed  Google Scholar 

  36. Dubuc M, Talajic M, Roy D, et al.: Feasibility of cardiac cryoablation using a transvenous steerable electrode catheter. J Interv Card Electrophysiol 1998, 2:285–292.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lickfett, L.M., Calkins, H.G. & Berger, R.D. Radiofrequency ablation for atrial fibrillation. Curr Treat Options Cardio Med 4, 295–306 (2002). https://doi.org/10.1007/s11936-002-0010-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-002-0010-8

Keywords

Navigation