The past, the present, and the future of cardiac arrhythmia ablation.

The development and evolution of percutaneous catheter ablation for the treatment of cardiac arrhythmias has advanced significantly since the early days of direct current shock ablation, and in parallel with an increasing understanding about arrhythmia mechanisms. Because of the ever-changing landscape that is cardiac electrophysiology, the purpose of this review is to discuss the future of invasive arrhythmia management within the context of the history and contemporary practice of this cardiac subspecialty. Topics of discussion include: (1) the evolution of ablation technologies from direct current shock and radiofrequency to alternative energy sources such as cryothermal ablation; (2) the use and development of nonfluoroscopic navigation systems; (3) the progression of ablation toolsets and modalities; and (4) the advancement of ablation strategies and techniques, including ablation of complex atrial and ventricular dysrhythmias tailored to the individual patient.