Catheter Ablation for the Management of Atrial Fibrillation: An Update of the Literature

SIMPLE SUMMARY: First-line treatment for restoring and maintaining sinus rhythm in patients with symptomatic atrial fibrillation (AF) involves the use of antiarrhythmic drugs. However, these are associated with significant side effects and have limited success rates in terminating AF episodes. In contrast, catheter ablation has been shown to be superior in maintaining sinus rhythm and improving the quality of life of AF patients. These procedures can also be performed via a hybrid set-up involving a minimally invasive surgical approach. These options have shown promise in restoring and maintaining sinus rhythm but are not without risks. Therefore, further studies investigating different ablative strategies are needed. ABSTRACT: Catheter ablation has been shown to be more effective at maintaining sinus rhythm and improving quality of life when compared to antiarrhythmic drugs. Radiofrequency and cryoablation are two effective methods. However, catheter-only ablation strategies have not consistently produced high success rates in treating longstanding and persistent AF patients. The emerging treatment of choice for such cases is hybrid ablation, which involves a multidisciplinary and minimally invasive approach to achieve surgical ablation of the direct posterior left atrial wall in combination with endocardial catheter ablation. Studies have shown promising results for the hybrid approach when compared with catheter ablation alone, but it is not without risks. Large and randomised studies are necessary to further evaluate these strategies for managing AF.