Catheter ablation of atrial fibrillation: Current status and near future

Atrial fibrillation (AF) is the most common sustained cardiac tachy-arrhythmia and is associated with reduced quality of life (QOL) and increased mortality and morbidity. Catheter ablation has become the curative treatment of choice for AF since the beginning of the 21st century. The main purpose of catheter ablation for AF is to eliminate symptoms relating to AF and improve QOL. The second, additional purpose is to improve outcomes and prognosis in AF patients. Recent large-scale randomized controlled trials (RCTs) sought to reveal the influence of AF ablation on the prognosis of these patients but failed to yield clear, new evidence of an improvement in the long-term prognosis. At present, however, catheter ablation for asymptomatic AF tends to be performed widely and aggressively, and the validity of the indication can be considered similar to that for symptomatic AF. Moreover, in a non-RCT study, it has been reported that ablation can improve the prognosis of patients with AF with or without symptoms. The JCS/JHRS guidelines have introduced an ablation indication for patients with asymptomatic AF, even if QOL is not reduced, as a Class IIb recommendation. Pulsed-field ablation is a non-thermal ablation technology that uses high-amplitude pulsed electrical fields to ablate tissues through the mechanism of irreversible electroporation. Due to its non-thermal nature and unique tissue-specific injury characteristics, it may have a superior safety profile as compared to that of alternate energy sources.