BMJ  2008;336:819-826 (12 April), doi:10.1136/bmj.39513.555150.BE

Clinical Review

Catheter ablation for atrial fibrillation

¹ Zena and Michael A Wiener Cardiovascular Institute, Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, Box 1030, New York, NY 10029, USA

The first 150 words of the full text of this article appear below.

Atrial fibrillation is the most common arrhythmia in clinical practice and is associated with significant morbidity and mortality.¹ Catheter ablation is increasingly being used to treat atrial fibrillation, although it is not suitable for all patients.² Referring doctors must confront challenges such as the appropriate selection of patients for ablation and proper management of patients after the procedure, and must be familiar with the expected outcomes. Many unanswered questions exist surrounding the appropriate application of this technique.

Summary points Atrial fibrillation is the most common arrhythmia in clinical practice Common triggers are ectopic pulmonary venous foci which conduct to the left atrium Catheter ablation techniques usually involve radiofrequency energy to electrically isolate the pulmonary veins from the left atrium Ablation may be more successful in patients with paroxysmal atrial fibrillation rather than persistent atrial fibrillation Atrial fibrillation ablation seems more successful than medical rhythm control therapy in carefully selected patients Ablation is . . . [Full text of this article]

Sources and selection criteria

What is catheter ablation of atrial fibrillation?

How have catheter ablation techniques evolved?

Box 1: Targets of current ablation techniques

How successful is ablation for atrial fibrillation?

Box 2: Summary of a recent consensus statement on catheter ablation of atrial fibrillation*
Indications
Contraindications
Technique
Thromboembolism prophylaxis after ablation
Minimal surveillance and monitoring after ablation
Repeat procedures

Which ablation technique is most efficacious?

Is catheter ablation superior to medical therapy?

Is catheter ablation safe?

Box 3: Potential major complications of catheter ablation of atrial fibrillation

Is thromboembolism prophylaxis necessary after ablation?

Who should be referred for catheter ablation?

Conclusion
Ongoing research
Additional educational resources
Information for patients
Tips for non-specialists

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