Indications for AF Ablation: Before or After the Failure of Antiarrhythmic Drug Therapy?

摘要

Catheter ablation of atrial fibrillation (AF) is considered to be better than anti-arrhythmic drug therapy in terms of maintaining sinus rhythm, and therefore it has evolved rapidly to become a commonly performed procedure in major hospitals throughout the world. However, according to the evidence currently available, we support the current guidelines recommending antiarrhythmic drugs as a first-line treatment in most patients with AF except for younger patients with symptomatic paroxysmal AF who have no evidence of structural heart disease, given the risk of fatal complications associated with the ablation procedure. It should be emphasized that institutional procedure volume and individual procedure experience are significant determinants of procedure-related complications. As another effect of AF ablation, the prevention of both atrial remodeling and the progression of paroxysmal AF to persistent AF is also noteworthy. Further long-term data is needed to answer the question of whether ablation can prevent or delay the advancement of structural remodeling and improve survival prognosis, particularly in younger patients.