Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies

Güney Sarıoğlu; Ertuğrul Kurtoğlu

Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies

Abstract

This review summarises the current indications for catheter ablation in the treatment of atrial fibrillation (AF), its fundamental technical principles, and new technologies. The effects of rhythm control, which is superior to drug therapy in symptomatic paroxysmal and persistent AF, reduction in AF burden, and potential mortality/functional improvement are discussed; the fundamental role of pulmonary vein isolation, additional substrate ablation strategies in persistent AF, special considerations in patients with concomitant Structural heart disease (SHD) and heart failure, and new energies such as pulsed field ablation are evaluated. AF catheter ablation, performed in suitable patients, with optimal timing and in experienced centres, is a key part of modern AF management. It greatly improves symptoms and can positively affect prognosis in some groups. Advances in technology and personalised strategies are expected to improve effectiveness and reduce risks.

Keywords

References

Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014;114(9):1453-1468. doi:10.1161/CIRCRESAHA.114.303211
Willems S, Wegner F, Eckardt L. Atrial fibrillation guideline group. clinical practice guideline: preventive measures and treatment options for atrial fibrillation. Dtsch Arztebl Int. 2025;122(16):439-444. doi:10. 3238/arztebl.m2025.0082
Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. Atrial fibrillation: pathogenesis, predisposing factors, and genetics. Int J Mol Sci. 2021;23(1):6. doi:10.3390/ijms23010006
Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217-221. doi:10.1177/1747493019897870
Elliott AD, Middeldorp ME, Van Gelder IC, Albert CM, Sanders P. Epidemiology and modifiable risk factors for atrial fibrillation. Nat Rev Cardiol. 2023;20(6):404-417. doi:10.1038/s41569-022-00820-8
Deshmukh A, Covassin N, Dauvilliers Y, Somers VK. Sleep disruption and atrial fibrillation: evidence, mechanisms and clinical implications. Circ Res. 2025;137(5):788-808. doi:10.1161/CIRCRESAHA.125.325612
Tzeis S, Gerstenfeld EP, Kalman J, et al. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2024;26(4): euae043. doi:10.1093/europace/euae043
AlTurki A, Essebag V. Atrial fibrillation ablation: impact on burden and cardiovascular outcomes. J Clin Med. 2025;14(8):2648. doi:10.3390/jcm14082648

Kowalewski M, Dąbrowski EJ, Kurasz A, et al. Surgical ablation of atrial fibrillation with concomitant cardiac surgery: a state-of-the-art review. Eur J Cardiothorac Surg. 2025;67(7):ezaf187. doi:10.1093/ejcts/ezaf187
Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomized clinical trial. Circulation. 2019;140(22):1779-1788. doi:10.1161/CIRCULATIONAHA.119.042622
Brundel BJJM, Ai X, Hills MT, Kuipers MF, Lip GYH, de Groot NMS. Atrial fibrillation. Nat Rev Dis Primers. 2022;8(1):21. doi:10.1038/s41572-022-00347-9
Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev. 2011;91(1):265-325. doi:10.1152/physrev.00031.2009
Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2):230-246. doi:10.1016/s0008-6363(02)00258-4
Dzeshka MS, Lip GY, Snezhitskiy V, Shantsila E. Cardiac fibrosis in patients with atrial fibrillation: mechanisms and clinical implications. J Am Coll Cardiol. 2015;66(8):943-959. doi:10.1016/j.jacc.2015.06.1313
Horrach CV, Bevis L, Nwanna C, et al. Atrial fibrosis in atrial fibrillation: Mechanisms, mapping techniques and clinical applications. J Physiol. 2025. doi:10.1113/JP288680
Boersma L, Andrade JG, Betts T, et al. Progress in atrial fibrillation ablation during 25 years of Europace journal. Europace. 2023;25(9): euad244. doi:10.1093/europace/euad244
Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol. 2021;18(3):210-225. doi:10.1038/s41569-020-00451-x
Sørensen SK, Johannessen A, Worck R, Hansen ML, Hansen J. Radiofrequency versus cryoballoon catheter ablation for paroxysmal atrial fibrillation: durability of pulmonary vein isolation and effect on atrial fibrillation burden: the RACE-AF randomized controlled trial. Circ Arrhythm Electrophysiol. 2021;14(5):e009573. doi:10.1161/CIRCEP. 120.009573
Quintanilla JG, Shpun S, Jalife J, Filgueiras-Rama D. Novel approaches to mechanism-based atrial fibrillation ablation. Cardiovasc Res. 2021; 117(7):1662-1681. doi:10.1093/cvr/cvab108
Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812-1822. doi: 10.1056/NEJMoa1408288
Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019;74(3):315-326. doi:10.1016/j.jacc.2019.04.021
Reddy VY, Calkins H, Mansour M, et al. Pulsed field ablation to treat paroxysmal atrial fibrillation: safety and effectiveness in the AdmIRE pivotal trial. Circulation. 2024;150(15):1174-1186. doi:10.1161/CIRCULATIONAHA.124.070333
Chun KJ, Miklavčič D, Vlachos K, et al. State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective. Europace. 2024;26(6):euae134. doi:10.1093/europace/euae134
Vlachakis PK, Theofilis P, Apostolos A, et al. Beyond pulmonary vein reconnection: exploring the dynamic pathophysiology of atrial fibrillation recurrence after catheter ablation. J Clin Med. 2025;14(9): 2919. doi:10.3390/jcm14092919
Ioannou A, Papageorgiou N, Lim WY, et al. Efficacy and safety of ablation index-guided catheter ablation for atrial fibrillation: an updated meta-analysis. Europace. 2020;22(11):1659-1671. doi:10.1093/europace/euaa224
Osorio J, Miranda-Arboleda AF, Velasco A, et al. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm. 2024;21(11):2083-2091. doi:10.1016/j.hrthm.2024.04.090
Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23): 2235-2245. doi:10.1056/NEJMoa1602014
Della Rocca DG, Marcon L, Magnocavallo M, et al. Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison. Europace. 2023;26(1): euae016. doi:10.1093/europace/euae016
Reddy VY, Gerstenfeld EP, Natale A, et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med. 2023; 389(18):1660-1671. doi:10.1056/NEJMoa2307291
Calvert P, Mills MT, Xydis P, et al. Cost, efficiency, and outcomes of pulsed field ablation vs thermal ablation for atrial fibrillation: a real-world study. Heart Rhythm. 2024;21(9):1537-1544. doi:10.1016/j.hrthm. 2024.05.032
Martins Esteves I, de Pontes VB, Trevisan T, Jaramillo S, Gomes WF. Pulsed-field ablation versus radiofrequency ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis. J Arrhythm. 2025;41(4):e70158. doi:10.1002/joa3.70158
Deepan N, Sripusanapan A, Prasitlumkum N, et al. Comparing efficacy and safety between pulsed field ablation, cryoballoon ablation and high-power short duration radiofrequency ablation in atrial fibrillation: a systematic review and network meta-analysis. J Interv Card Electrophysiol. 2025;68(5):1053-1063. doi:10.1007/s10840-025-02033-8
33. Kirchhof P, Calkins H. Catheter ablation in patients with persistent atrial fibrillation. Eur Heart J. 2017;38(1):20-26. doi:10.1093/eurheartj/ehw260
Hu X, Biase LD, Hou X, Liu X. Persistent atrial fibrillation ablation: glimpsing the light ahead? Europace. 2025;27(6):euaf037. doi:10.1093/europace/euaf037
Reddy VY, Morales G, Ahmed H, et al. Catheter ablation of atrial fibrillation without the use of fluoroscopy. Heart Rhythm. 2010;7(11): 1644-1653. doi:10.1016/j.hrthm.2010.07.011
Bohnen M, Minners J, Eichenlaub M, et al. Feasibility and safety of a three-dimensional anatomic map-guided transseptal puncture for left-sided catheter ablation procedures. Europace. 2023;25(3):1126-1134. doi: 10.1093/europace/euac262
Di Biase L, Burkhardt JD, Mohanty P, et al. Periprocedural stroke and management of major bleeding complications in patients undergoing catheter ablation of atrial fibrillation: the impact of periprocedural therapeutic international normalized ratio. Circulation. 2010;121(23): 2550-2556. doi:10.1161/CIRCULATIONAHA.109.921320
Cardoso R, Knijnik L, Bhonsale A, et al. An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation. Heart Rhythm. 2018;15(1):107-115. doi:10.1016/j.hrthm.2017.09.011
Nakamura K, Naito S, Sasaki T, et al. Uninterrupted vs. interrupted periprocedural direct oral anticoagulants for catheter ablation of atrial fibrillation: a prospective randomized single-centre study on post-ablation thrombo-embolic and haemorrhagic events. Europace. 2019;21(2):259-267. doi:10.1093/europace/euy148
Yamamoto T, Miyazaki S, Tanaka Y, et al. Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing atrial fibrillation ablation: results from the multicentre end-stage kidney disease-atrial fibrillation ablation registry. Europace. 2023;25(4):1400-1407. doi:10.1093/europace/euad056
du Fay de Lavallaz J, Badertscher P, Ghannam M, et al. Severe periprocedural complications after ablation for atrial fibrillation: an international collaborative individual patient data registry. JACC Clin Electrophysiol. 2024;10(7 Pt 1):1353-1364. doi:10.1016/j.jacep.2024.03.024
Guan F, Gass M, Berger F, Akdis D, Duru F, Wolber T. Transseptal puncture guided by three-dimensional electroanatomical mapping: early experience using a simplified approach in adults with congenital heart disease. J Clin Med. 2023;12(13):4491. doi:10.3390/jcm12134491
Brasca FMA, Menè R, Perego GB. Catheter ablation for atrial fibrillation in structural heart disease: a review. J Clin Med. 2023;12(4):1431. doi:10. 3390/jcm12041431
Packer DL, Piccini JP, Monahan KH, et al. Ablation versus drug therapy for atrial fibrillation in heart failure: results from the CABANA trial. Circulation. 2021;143(14):1377-1390. doi:10.1161/CIRCULATIONAHA.120.050991
Assaf A, Feng H, Bsoul M, et al. Characterization of arrhythmia-induced cardiomyopathy using magnetic resonance imaging in patients with persistent atrial fibrillation and left ventricular systolic dysfunction-insights from DECAAF II. Eur J Heart Fail. 2025;27(9):1622-1632. doi: 10.1002/ejhf.3684
Mistrulli R, Ferrera A, Muthukkattil ML, et al. Atrial fibrillation in patients with hypertrophic cardiomyopathy and cardiac amyloidosis: from clinical management to catheter ablation indication. J Clin Med. 2024;13(2):501. doi:10.3390/jcm13020501
Ekanem E, Neuzil P, Reichlin T, et al. Safety of pulsed field ablation in more than 17,000 patients with atrial fibrillation in the MANIFEST-17K study. Nat Med. 2024;30(7):2020-2029. doi:10.1038/s41591-024-03114-3
Wyler von Ballmoos MC, Hui DS, Mehaffey JH, et al. The Society of Thoracic Surgeons 2023 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg. 2024;118(2):291-310. doi:10.1016/j.athoracsur.2024.01.007

Details

Primary Language

English

Subjects

Cardiology

Journal Section

Review

Authors

Güney Sarıoğlu ^*
0000-0002-1049-1873
Türkiye

Ertuğrul Kurtoğlu
0000-0001-5835-087X
Türkiye

Publication Date

May 22, 2026

Submission Date

February 23, 2026

Acceptance Date

May 10, 2026

Published in Issue

Year 2026 Volume: 8 Number: 3

IZ

https://izlik.org/JA88RC33TN

Cite

RIS / Bibtex

APA

Sarıoğlu, G., & Kurtoğlu, E. (2026). Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies. Anatolian Current Medical Journal, 8(3), 582-587. https://izlik.org/JA88RC33TN

AMA

1.Sarıoğlu G, Kurtoğlu E. Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies. Anatolian Curr Med J / ACMJ / acmj. 2026;8(3):582-587. https://izlik.org/JA88RC33TN

Chicago

Sarıoğlu, Güney, and Ertuğrul Kurtoğlu. 2026. “Catheter Ablation for Atrial Fibrillation: A Contemporary Narrative Review of Indications, Techniques, and Emerging Technologies”. Anatolian Current Medical Journal 8 (3): 582-87. https://izlik.org/JA88RC33TN.

EndNote

Sarıoğlu G, Kurtoğlu E (May 1, 2026) Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies. Anatolian Current Medical Journal 8 3 582–587.

IEEE

[1]G. Sarıoğlu and E. Kurtoğlu, “Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 3, pp. 582–587, May 2026, [Online]. Available: https://izlik.org/JA88RC33TN

ISNAD

Sarıoğlu, Güney - Kurtoğlu, Ertuğrul. “Catheter Ablation for Atrial Fibrillation: A Contemporary Narrative Review of Indications, Techniques, and Emerging Technologies”. Anatolian Current Medical Journal 8/3 (May 1, 2026): 582-587. https://izlik.org/JA88RC33TN.

JAMA

1.Sarıoğlu G, Kurtoğlu E. Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies. Anatolian Curr Med J / ACMJ / acmj. 2026;8:582–587.

MLA

Sarıoğlu, Güney, and Ertuğrul Kurtoğlu. “Catheter Ablation for Atrial Fibrillation: A Contemporary Narrative Review of Indications, Techniques, and Emerging Technologies”. Anatolian Current Medical Journal, vol. 8, no. 3, May 2026, pp. 582-7, https://izlik.org/JA88RC33TN.

Vancouver

1.Güney Sarıoğlu, Ertuğrul Kurtoğlu. Catheter ablation for atrial fibrillation: a contemporary narrative review of indications, techniques, and emerging technologies. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 May 1;8(3):582-7. Available from: https://izlik.org/JA88RC33TN