Drug therapy and catheter ablation for atrill fibrillation

In all clinical trials comparing rate versus rhythm control of atrial fibrillation (AF) by drugs, there was no survival benefit associated with a rhythm control strategy. Currently used antiarrhythmic drugs are not only frequently ineffective at eliminating AF, but may be life threatening In some patients. Catheter ablation (CA) of AF has evolved rapidly and has become accepted as one of the therapeutic modalities for controlling AF. The effective strategies for CA of AF consist of pulmonary vein isolation (PVI) and/or complete encirclement around PVs with or without additional ablation lines. Selection of patients, who may be benefited by CA or not, Is an important Issue. Precise electroanatomic mapping for the triggers and the substrate of the atria is central for customizing ablation target and for enhancing efficacy of CA for AF. With further development of new energy sources of ablation, cardiac imaging, navigation, and mapping systems, the CA can be simplified and standardized, which may enable the CA to become more effective, safer, and more applicable to many different subsets of AF.