title: Contemporary challenges of catheter ablation for atrial fibrillation.
abstract: OBJECTIVE
  Catheter ablation of atrial fibrillation (AF) is now one of the most frequently performed ablation procedures, but there are currently 2 important challenges: achieving permanent/durable rather than transient pulmonary vein isolation (PVI) and improving the results of ablation for the wider patient population with persistent AF.
  
  
  METHODS
  Recent technical advances in the technique of ablation and the results of clinical trials aimed at achieving more permanent and durable PVI are reviewed. We also summarize recent advances in identifying atrial fibrosis and in understanding the pathophysiology of AF relevant to selecting patients for ablation of persistent AF.
  
  
  RESULTS
  The use of contact force-sensing technology, adenosine testing after ablation, and pace capture-guided ablation all have the potential for achieving more durable ablation. Selection of patients suitable for ablation of persistent AF may be improved by assessing the extent of atrial fibrosis with delayed enhancement imaging with cardiac magnetic resonance or by assessing the pattern of atrial electrical activity with the use of complex atrial electrograms. Advances in treatment are likely to result from the recognition of localized rotors and focal sources as primary sustaining mechanisms for all types of human AF and in the use of noninvasive mapping for their identification. Linear ablation to supplement PVI may improve the results of AF ablation.
  
  
  CONCLUSIONS
  Rapidly unfolding advances in the techniques of AF ablation and the understanding of mechanisms of AF hold promise for improving the durability of PVI and for extending the technique to carefully selected patients with persistent AF.
authors.affiliation: University of Western Australia, Crawley, Royal Perth Hospital, Perth, Hollywood Private Hospital, Nedlands, Western Australia, Australia. Electronic address: rukshen@gmail.com.
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.affiliation: University of Bordeaux, Bordeaux, Hôpital Cardiologique du Haut-Leveque, Pessac, France.
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.affiliation: University of Bordeaux, Bordeaux, Hôpital Cardiologique du Haut-Leveque, Pessac, France.
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: University of Bordeaux, Bordeaux, Hôpital Cardiologique du Haut-Leveque, Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: University of Bordeaux, Bordeaux, Hôpital Cardiologique du Haut-Leveque, Pessac, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000241:Adenosine / Q000032:analysis; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D018579:Patient Selection; D011667:Pulmonary Veins; D016896:Treatment Outcome
chemical_list: D000241:Adenosine
keywords: arrhythmia; atrial fibrillation; catheter ablation; review