Catheter ablation of atrial fibrillation: do we know what we are doing?

Although atrial fibrillation (AF) represents the most common arrhythmia that is seen in every day cardiology practice, the surgeons, and not the cardiologists, were the first to take the initiative for its radical cure. Cox and colleagues developed the Maze procedure and its modifications in the 80s followed by the pioneering attempt of Swartz et al. to ablate the arrhythmia in the electrophysiology laboratory in 1994. Now, catheter ablation is an established therapeutic option for certain patients with AF. Several ablation strategies have emerged which, although extremely diverse, report similar success rates, in the range of 60–80%, with 30–40% of patients followed for a year or two having had two procedures, however, different endpoints and methodology of assessment of AF recurrence make interpretation of success rather difficult. It is of interest that despite the considerable clinical experience and accumulated evidence from experimental data, the exact mechanism of eliminating AF by catheter ablation techniques is still unknown.