Radiofrequency ablation for atrial fibrillation

  The 2006 ACC/AHA/ESC Guidelines for the Treatment of Atrial Fibrillation recommend catheter ablation for the prevention of recurrent AF in addition to pharmacologic therapy in patients with symptomatic AF (Class IIa), and the 2006 Current Knowledge and Recommendations for the Treatment of Atrial Fibrillation in China also recommend catheter ablation for patients with recurrent paroxysmal AF (age < 75 years, no significant organic heart disease, left atrial diameter < 50 mm). Catheter ablation can be the first-line treatment in experienced electrophysiology centers.  The current success rate of catheter ablation for paroxysmal atrial fibrillation is 80-90%, and the majority of enrolled cases are patients who have failed drug therapy, so the actual effectiveness of catheter ablation for atrial fibrillation should be much greater than the efficacy of drug therapy alone (approximately 40%).  For experienced electrophysiology centers, catheter ablation is equally effective for persistent AF, combined atrial enlargement, heart failure, and AF with organic heart disease.  The clinical feasibility of catheter ablation of AF is unquestionable. For experienced electrophysiology centers, the procedure time to complete catheter ablation of paroxysmal AF is about 2 hours, which is comparable to the time for radiofrequency ablation of modified AV node or right-sided bypass, and for chronic AF, the ablation time does not exceed 4-5 hours. The incidence of complications such as left atrial stenosis, stroke, and left esophageal fistula is <1%; catheter ablation of atrial fibrillation is also safe as long as adequate preoperative preparation, understanding of the anatomy of the left atrium and pulmonary veins, strict intraoperative operation according to specifications, and timely detection of early signs of complications are carried out.  Another common scenario is the occurrence of tachyarrhythmias after atrial fibrillation ablation, with an incidence ranging from 1.2% to 21% (mean 8%), mostly seen within days to weeks after ablation. The presence of a conduction gap (gap) in the circumferential pulmonary vein ablation line is the predominant mechanism for its occurrence. Other mechanisms include large intra-atrial folding atrial tachycardia (the folding pathway is mostly associated with the posterior wall of the left atrium between the mitral isthmus and/or the annular ipsilateral pulmonary vein antrum ablation line) and focal atrial tachycardia.  Some of the atrial tachycardias after atrial fibrillation ablation may resolve spontaneously within 2 to 5 months after the procedure, probably related to tissue fibrosis at the ablation line and gradual disappearance of the conduction gap.