Catheter ablation of atrial fibrillation (AF) has made considerable advances over the past decade. Although pulmonary vein (PV) isolation has proven to be a reliable curative treatment, especially for paroxysmal AF, it still has several issues to resolve. Because the AF mechanisms are complex and multifactorial, especially in persistent or permanent AF, they cannot be eliminated altogether by PV isolation alone. Beyond PV isolation, several other techniques have shown promise in improving the long-term success. Several recent reports comparing the superiority between AF ablation and antiarrhythmic drug therapy have shown early evidence suggesting that AF ablation warrants consideration as a first-line therapy in selected patients. Copyright © 2007 by Current Medicine Group LLC.