Abstract
Catheter ablation has become the treatment of choice for atrial fibrillation in symptomatic patients who are refractory to antiarrhythmic medication. The predominant mechanism for initiation of atrial fibrillation is electrical activity originating from the pulmonary veins. Most ablation strategies are centered on electrical isolation of pulmonary veins. To successfully perform this ablation and decrease complications such as pulmonary vein stenosis, atrioesophageal fistula formation, and tamponade, the left atrial and pulmonary vein anatomy must be well understood. Imaging techniques have rapidly evolved over the past several years to aid in accurate display of cardiac anatomy. Electrophysiologists must understand how to integrate these imaging tools and recognize the relative strengths and pitfalls of each tool. Intracardiac echocardiography, three-dimensional electroanatomical mapping, and CT or MRI are often integrated during the procedure. Newer technologies are also on the horizon to aid in even better understanding of anatomy and catheter navigation.
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