Katheterablation von Vorhofflimmern

Updated appraisal of catheter ablation in atrial fibrillation. Catheter ablation is a cornerstone for management of patients with atrial fibrillation (AF). Numerous prospective randomised trials have demonstrated the superiority of catheter ablation over antiarrhythmic drug therapy in patients with AF with regard to sinus rhythm maintenance and quality of life. This particularly applies to patients with paroxysmal AF and normal heart structure. For this patient population, the scientific community’s guidelines currently recommend catheter ablation following initial failure of antiarrhythmic drug therapy. While AF ablation can be considered for first-line therapy in a selected group of patients, it is worth noting that currently available ablation techniques are still complex and time-consuming. Moreover, these techniques also still present a risk of potentially fatal procedural-related complications, such as atrio-oesophageal fistula, stroke, or cardiac tamponade. Though rare, such complications must be taken into account for all treatment-related decisions of both patients and physicians. In recent years, significant and rapid progress has been made, with different kinds of novel ablation techniques becoming available. With the advent of radiofrequency energy ablation in the 1980s, no one would have predicted that, today, catheter ablation would be the most commonly used ablation method in atrial fibrillation management.