Clinical Review

Catheter ablation for atrial fibrillation

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39513.555150.BE (Published 10 April 2008) Cite this as: BMJ 2008;336:819
  1. Steven A Lubitz, clinical cardiology fellow1,
  2. Avi Fischer, assistant professor of medicine1,
  3. Valentin Fuster, professor of medicine1
  1. 1Zena 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
  1. Correspondence to: S A Lubitz steven.lubitz{at}mssm.edu
  • Accepted 27 February 2008

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 indicated in patients requiring rhythm control and who have failed with at least one antiarrhythmic drug

  • Long term data on the safety and efficacy of atrial fibrillation ablation are limited

This review summarises current ablative techniques and emphasises the appropriate application and limitations of catheter ablation on the basis of recent clinical trials and guidelines.

Sources and selection criteria

We searched all entries in PubMed through September 2007 with the medical subject headings “atrial fibrillation”, “catheter ablation”, and “anti-arrhythmia agents”. We reviewed the reference lists of retrieved articles to identify any additional relevant articles for inclusion. Whenever available, we chose randomised controlled trials and meta-analyses over prospective cohort studies. When these were not available, we cited retrospective studies. We included other references if judged relevant for the purposes of discussion. Thus this work is not an exhaustive review but represents an overview of current clinical and technical aspects pertaining to catheter ablation …

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