Atrial Fibrillation Ablation: Are We Still Looking for the Best Shot?

Atrial fibrillation (AF) is independently associated with increased risks of mortality, stroke, heart failure, impaired quality of life, and cognitive decline. Rhythm control has proven superior to rate control in reducing cardiovascular outcomes, with catheter ablation demonstrating greater efficacy than antiarrhythmic drug therapy.^– Continuous advances in techniques and technologies have progressively established ablation as a cornerstone in the management of AF.

In recent years, 3D mapping and point-by-point ablation have evolved significantly with the introduction of contact force-sensing catheters and the development of lesion quality metrics, such as the Ablation Index and Lesion Size Index. These improvements have translated into better outcomes, reduced procedure times, and enhanced safety.^– Pulmonary vein isolation remains the cornerstone of invasive AF treatment, with radiofrequency (RF) point-by-point ablation still being the most widely used technique despite the emergence of alternative energy sources. Procedural success relies on delivering continuous, irreversible, and transmural lesions encircling the pulmonary veins while sparing adjacent structures, such as the esophagus and phrenic nerve.

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