Nonpharmacologic Strategies: The Evolving Story of Ablation and Hybrid Therapy

Technologic advancements have resulted in the more widespread use of catheter ablation to restore sinus rhythm in patients with atrial fibrillation (AF) and elicit improvement in symptoms, quality of life, and prognosis. However, the effectiveness of this procedure to prevent the occurrence of heart failure and stroke while reducing mortality has yet to be proved in major clinical trials. Factors influencing the results of ablation and possibly obfuscating the interpretation of data from early studies include variations in center experience and operator skill, the definition of procedural success, and follow-up interval and duration, as well as the complexity and heterogeneity of AF itself. Upcoming trials that will examine outcomes after catheter ablation and pharmacologic strategies from the end points of heart failure, stroke, and mortality are anticipated to yield more definitive conclusions about ablation efficacy.