Catheter ablation for atrial fibrillation: current indications and evolving technologies.
Ramanathan ParameswaranAhmed M Al-KaiseyJonathan M KalmanPublished in: Nature reviews. Cardiology (2020)
Catheter ablation for atrial fibrillation (AF) has emerged as an important rhythm-control strategy and is by far the most common cardiac ablation procedure performed worldwide. Current guidelines recommend the procedure in symptomatic patients with paroxysmal or persistent AF who are refractory or intolerant to antiarrhythmic drugs. The procedure might also be considered as a first-line approach in selected asymptomatic patients. Data from large registries indicate that AF ablation might reduce mortality and the risk of heart failure and stroke, but evidence from randomized controlled trials is mixed. Pulmonary vein isolation using point-by-point radiofrequency or with the cryoballoon remains the cornerstone technique in AF ablation. Additional atrial ablation can be performed in patients with persistent AF, but its benefits are largely unproven. Technological advances in the past decade have focused on achieving durable vein isolation, reducing procedure duration and improving safety. Numerous exciting new technologies are in various stages of development. In this Review, we discuss the relevant data to support the recommended and evolving indications for catheter ablation of AF, describe the different ablation techniques, and highlight the latest advances in technology that aim to improve its safety and efficacy. We also discuss lifestyle modification strategies to improve ablation outcomes.
Keyphrases
- catheter ablation
- atrial fibrillation
- left atrial
- heart failure
- left atrial appendage
- oral anticoagulants
- direct oral anticoagulants
- minimally invasive
- percutaneous coronary intervention
- metabolic syndrome
- randomized controlled trial
- left ventricular
- end stage renal disease
- newly diagnosed
- clinical trial
- physical activity
- chronic kidney disease
- adipose tissue
- systematic review
- weight loss
- venous thromboembolism
- risk factors
- machine learning
- deep learning
- artificial intelligence
- ultrasound guided
- radiofrequency ablation