Catheter ablation is now at the forefront of the management of symptomatic atrial fibrillation (AF). Its role in paroxysmal AF is well defined with considerable data supporting its role. Catheter ablation in persistent AF has been less effective and the subject of considerable debate. Mechanistic studies have demonstrated the critical role of pulmonary vein physiology in paroxysmal AF, whereas the mechanisms that sustain persistent AF are not well understood. Additional substrate ablation in persistent AF has not improved long-term outcomes and the use of novel mapping technologies to assess rotor activity remains controversial. This review will focus on the current understanding of the mechanistic basis of paroxysmal and persistent AF, the role of catheter ablation and, recent advances in the management of these complex arrhythmias.
- Atrial fibrillation
- Catheter ablation
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine