Controversies in the atrial fibrillation сatheter ablations

  • А. Doronin Shupyk National Medical Academy of Postgraduate Education (Kyiv)
  • М. Meshkova Ukrainian Children’s Cardiac Center (Kyiv)
  • Y. Marushko Ukrainian Children’s Cardiac Center (Kyiv)
Keywords: atrial fibrillation, catheter ablation, ablation results, complications


For now there is no single technique of radiofrequency (RF) catheter ablation of atrial fibrillation (AF). We decided to analyze the main methodics of AF radiofrequency catheter ablation currently used.

We analyzed the literature data and our own results.

Many authors have recognized that in paroxysmal AF electrical isolation of the pulmonary veins is enough, but in non-paroxysmal AF we need to use a step by step methodology: in addition to PV isolation performing atrial fragmentation and modification of the arrhythmia substrate. However, there were studies that show advisability of the step by step procedure in paroxysmal AF, and inefficacy when it was used in patients with non-paroxysmal AF. Despite significant progress in the medical equipment and experience accumulation, efficiency of the catheter treatment of AF is not improved. It is considered that the risk of complications reducing when using of the irrigated catheters, but in 430 consecutive patients, who received AF catheter ablation in our center, we had no complications that could be associated with the use of non-irrigated catheters.

There are many unresolved issues in the AF radiofrequency catheter treatment. The ablation technique that we applied is quite effective, safe and economically feasible.


1. Pulmonary venous isolation versus additional substratemodification as treatment for paroxysmal atrial fibrillation / Gavin A. R., Singleton C. B., Bowyer J. et al. // J Interv Card Electrophysiol. – 2012. – Vol. 33. – P. 101–107.

2. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation / Calkins H., Kuck K. H., Cappato R., et al. // Europace. – 2012. – Vol. 14. – P. 528–606.

3. Catheter ablation of longstanding persistent atrial fibrillation: Let sleeping dogs lie / Sairaku A., Nakano Y., Kihara Y. // International Journal of Cardiology. – 2015. – Vol. 181. – P. 104–105.

4. Predictors and Characteristics of Multiple (More Than 2) Catheter Ablation Procedures for Atrial Fibrillation / Lo L. W., Lin Y. J., Chang S. L. et al. // J Cardiovasc Electrophysiol. – 2015. – Vol. 10. – P. 1048–56.

5. Ghosh J. M. The Full Circle: Back into the Pulmonary Veins: A New Possibility in AF Ablation? / Ghosh J. M., MCGuire M. A. // J Cardiovasc Electrophysiol. – 2015. – Vol. 26. – P. 1007–1008.

6. Stepwise ablation approach versus pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Randomized controlled trial / Faustino M., Pizzi C., Agricola T. // Heart Rhythm. – 2015. – Vol. 12 (9). – P. 1907–15.

7. Importance of non-pulmonary vein triggers ablation to achieve long-term freedom from paroxysmal atrial fibrillation in patients with low ejection fraction / Natale A., Zhao Y., Di Biase L. // Heart Rhythm. – 2016. – Vol. 1. – P. 141–9.

8. Approaches to Catheter Ablation for Persistent Atrial Fibrillation / Verma A., Jiang C. Y., Betts T. R., et al. // N Engl J Med. – 2015. – Vol. 372. – P. 1812–22.

9. Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial / Vogler J., Willems S., Sultan A. et al. // J Am Coll Cardiol. – 2015. – Vol. 66 (24). – P. 2742–2752.

10. Biatrial linear ablation in sustained nonpermanent AF: Results of the substrate modification with ablation and antiarrhythmic drugs in nonpermanent atrial fibrillation (SMAN-PAF) trial / Wynn G. J., Panikker S., Morgan M. et al. // Heart Rhythm. – 2016. – Vol. 13. – P. 399–406.

11. Latchamsetty R. Catheter Ablation of Atrial Fibrillation / Latchamsetty R., Morady F. // Heart Failure Clin. – 2016. – Vol. 12 (2). – P. 223–233.

12. Dass M. et al. Pulmonary vein Re-isolation as a routine strategy // UK, Cardiostim, 2016.
How to Cite
DoroninА., MeshkovaМ., & Marushko, Y. (2016). Controversies in the atrial fibrillation сatheter ablations. Ukrainian Journal of Cardiovascular Surgery, (3 (26), 97-99. Retrieved from