Atrial fibrillation ablation: state of the art.

Among several catheter-based strategies for curing atrial fibrillation (AF), 2 approaches have emerged as dominant strategies in current clinical practice: ostial segmental disconnection of all pulmonary veins (PVs) from the adjacent atrial tissue and circumferential PV ablation, first reported by our laboratory in Milan. The cure for AF by circumferential PV ablation has had a dramatic impact on morbidity, quality of life, and even mortality in patients with the most frequent cardiac arrhythmia. The last 10 years of AF ablation are characterized by a better understanding of AF mechanisms as well as by new and evolving concepts associated with innovation in technologies. We recently demonstrated, for the first time, the role of vagal denervation in enhancing long-term benefits from circumferential PV ablation. Unlike other strategies, our strategy was associated with high success rates in both paroxysmal and chronic AF. As a result, our initial approach did not substantially change over time, and now we have long-term results after >3 years of follow-up. Recently, we demonstrated the safety and feasibility of remote magnetic navigation of a soft magnetic-tip catheter within the left atrium, even at challenging sites for both mapping and ablation in patients with AF. Use of a robotic navigation system has begun a new era in interventional cardiac electrophysiology-without risk of major complications, such as cardiac tamponade or atrioesophageal fistula, even in less experienced laboratories.