[Catheter ablation of persistent atrial fibrillation : Where do we go?]

Despite the very promising initial results of clinical studies, catheter ablation of persistent atrial fibrillation (AF) remains a challenge in modern electrophysiology. On the basis of the hypothesized pathophysiological mechanisms, a variety of ablation strategies have been developed over the course of time. The current ablation strategies range from pulmonary vein isolation (PVI) alone as first-line therapy, through ablation of multiple linear lesions, ablation of complex fractionated atrial electrograms (CFAE), rotor ablation, isolation of fibrotic and scar tissue up to isolation of the left atrial appendage (LAA); however, it is unclear even to the present day whether these complex and time-consuming strategies actually improve the success rate of ablation therapy. In recent years it has reproducibly been shown that with these ablation techniques more than one procedure is often necessary in order to achieve a stable sinus rhythm and even then only limited satisfactory success rates can be expected. The only currently established ablation endpoint is PVI. The stringent treatment of risk factors, such as arterial hypertension and obesity is becoming a focus of interest as an additive concept to ablation.