[Catheter ablation of atrial fibrillation in patients with structural heart disease: when to think about it?].

Atrial fibrillation (AF) is the most frequent supraventricular arrhythmia. It is associated with increased morbidity and mortality but its management is still under debate. The limited success of drug treatment has stimulated an exploration of interventional treatment options. Therefore, in the past decade, various ablative procedures, both surgical and transcatheter, have been proposed. Catheter ablation has involved mainly patients without structural heart disease. In the series published to date the percentage of patients with structural heart disease undergoing catheter ablation for AF is about 20%. These patients would benefit the most from the maintenance of sinus rhythm but on the other hand data show a higher post-procedural recurrence rate. In patients with valvular heart disease and indication to surgical repair or valvular replacement, surgical ablation is indicated in the majority of cases. Catheter ablation in patients with heart failure and AF should be considered when the occurrence of AF worsens the prognosis and the functional class and antiarrhythmic therapy has failed. In patients with hypertrophic cardiomyopathy and AF, the present data warrant an aggressive approach proposing catheter ablation early in the course of the disease when AF is paroxysmal, and electrical and structural remodeling does not impair its efficacy. However, these preliminary data need to be evaluated in a long-term follow-up to better define the role of catheter ablation in patients with AF and structural heart disease.