[Recent advances in radiofrequency catheter ablation for atrial fibrillation].

Failure to control the ventricular rate in atrial fibrillation (AF) can be treated by radiofrequency (RF), ablation or modification of atrioventricular (AV) node. AV nodal ablation with pacemaker and AV nodal modification are associated with significant improvement in symptoms and quality of life. But there is no evidence that these techniques influence survival, and in some cases these therapies must be followed by implantation of a permanent pacemaker (due to complete AV block), and anticoagulation (due to persistence of underlying AF). The maze operation attempts to abolish AF by channeling the atrial activation between a series of incisions. Early results are encouraging, and simultaneous surgery may be beneficial. RF ablation can be used to create long linear lesions for this purpose (catheter maze). Preliminary studies show a higher success rate when linear ablations are performed in the left atrium than in the right atrium and that arrhythmogenic foci play a significant role in atrial fibrillation. However, catheter mazes are prolonged, and it is difficult with current technology to create endocardial linear lesions consistently that act as barriers to conduction. It is required to optimize this to transform investigational technique into a routine procedure. In specific cases, focal ablation or catheter ablation of the right atrial only can prevent AF. It may be possible that different approaches of ablation may be required, depending on the etiology. Curative radiofrequency catheter ablation for patients with AF may not be far in the future.