Atrial Fibrillation Ablation: When and Why?

Abstract

Ablation of Atrial Fibrillation (AF) has quickly become an alternative strategy to impact the adverse symptoms and outcomes associated with or caused by AF. Early reports in 1998 demonstrated spontaneous initiation of AF by ectopic beats originating in the Pulmonary Veins (PVs) followed rapidly by showing that Radio Frequency (RF) circumferential ablation around the orifices of the PVs could “electrically disconnect” the PVs from the Left Atria (LA). This resulted in the explosive growth utilizing this procedure for AF Ablation (AFA) across a wide demographic spectrum of recipients. Foreseeable healthy debates have surfaced as to who best benefits and who may actually suffer complications or harm from AFA utilizing present techniques. Disagreement also persists as to whether AFA fundamentally and universally reduces stroke, death, hospitalization or does it initiate a more nuanced set of outcomes. The present effort asks the simple question: Has AFA matured to the point of requisite explicative review? Is it time now to peel back the layers and identify which cohort will be optimally served by AFA and perhaps which ones need demonstration of benefit? The present brief review suggests that prudent employment of AFA must now identify disparities in the variables reflected in these cohort outcomes. This will enable judgment in the use of AFA and the achievement of optimal outcomes.