MODERN METHODS OF CATHETER TREATMENT OF ATRIAL FIBRILLATION. CURRENT STATUS OF THE ISSUE

Highlights An overview of the latest literature data on the evidence base of invasive treatment of atrial fibrillationusing pulmonary vein isolation and additional effects on the left atrium is presented. Summary Atrial fibrillation (AF) is currently the most common arrhythmia encountered in clinical practice. The number of patients is rapidly increasing and over the past 50 years the prevalence of the disease has shown a threefold increase. Despite its non-infectious nature, experts equate the disease to the epidemic of the current century. It has been reliably proven that AF contributes to the development and progression of such dangerous conditions as chronic heart failure, stroke, pulmonary embolism, and arrhythmogenic cardiomyopathy. A rhythm control strategy not only helps relieve arrhythmia symptoms, reducing the burden of patients with AF, but also prevents the diseases described above. Based on the results of current data, catheter-based techniques for the treatment of atrial fibrillation show better efficacy results compared to drug therapy. At the moment, the question of the technique of performing the ablation procedure for different forms of atrial fibrillation remains open. An urgent aspect remains increasing the effectiveness of interventions in different groups of patients. There are both established techniques for isolating the pulmonary veins, with proven effectiveness in numerous studies, and new directions for improving the procedure, including isolation of the posterior wall of the left atrium, additional effects on the autonomic ganglion plexuses, complex fragmented electrograms and isolation of the superior vena cava. The review article presents a variety of intervention options, in accordance with the form of atrial fibrillation and its mechanisms of pathogenesis, as well as data from recent studies reflecting the influence of additional interventions in the left atrium on the effectiveness of the intervention. Ablation techniques are described in detail, taking into account the constant improvement of the medical devices used and the desire to standardize the procedure. Also presented are current diagnostic methods aimed at the most accurate detection of episodes of fibrillation and an objective assessment of the effectiveness of the treatment.