Targeting ablation strategies and electro-anatomical systems for different atrial fibrillation patterns

INTRODUCTION: Catheter ablation (CA) is an established and widespread treatment option for drug refractory atrial fibrillation (AF). CA has undergone considerable improvements during the last years and several ablation strategies have been proposed for different AF patterns. EVIDENCE ACQUISITION The main cornerstone is the electrical isolation of pulmonary veins (PVs) especially among patients with paroxysmal AF. This can be achieved mainly with the use of radiofrequency or cryo-energy. However ablation strategy remains uncertain in patients with persistent AF. EVIDENCE SYNTHESIS Several mapping systems have been developed in order to acquire electrical and anatomical information of the left and right atrium. For patients with persistent atrial fibrillation new systems are able to identify potential AF triggers arising out of the PVs, but the role of ablation of this triggers is still not clear. CONCLUSIONS Although several improvements have been performed in CA of AF, the main cornerstone of treatment remains the electrical isolation of PVs. This approach provides good clinical results at long-term follow-up in patients with paroxysmal AF. However, the ablation strategy apart from electrical isolation of PV in patients with persistent AF is still not well defined. Further improvement of mapping systems could provide more information about alternative ablation strategies.