Ablation should not be first-line therapy for the treatment of atrial fibrillation

The introduction of new techniques into medical practice frequently results in uncertainty for potential referring physicians and patients alike. The development of safe and effective percutaneous techniques for the cure of symptomatic Wolff-Parkinson-White (WPW) syndrome quickly led to near-elimination of the use of cardiac surgery and antiarrhythmic drugs to treat this proarrhythmic condition, and is justly regarded as a triumph of innovation by both electrophysiologists and biomedical engineers. The introduction of balloon angioplasty also led to a reduction in the number of patients referred for surgical procedures, although with arguably less rationale. An excess of popular enthusiasm among patients and physicians for this procedure made critical debate (continuing in academic circles) moot, at least in the USA. In this paper, I will argue that radiofrequency ablation for the treatment of atrial fibrillation is more akin to the use of angioplasty and less like the treatment of WPW, and cannot be justified as first-line therapy. Unfortunately, excessively optimistic characterization of ablation for atrial fibrillation is obscuring critical issues that ought to be considered by electrophysiologists, referring physicians and patients.