Atrial fibrillation (AF) is the commonest cardiac rhythm disorder, affecting about 5% of elderly patients. Despite the wide spread prevalence of AF, treatment options for the condition up until recently, were limited. Antiarrhythmic drug therapy which for a long time had been and to some extent still is the cornerstone for treating these patients, has shown a disappointing (£ 40%) efficacy for long-term maintenance of sinus rhythm. The seminal observations by Haissaguerre and colleagues demonstrating AF initiation from electrical depolarizations in the pulmonary veins (PV) and cure of AF in these patients by radiofrequency ablation (RFA) of the PV focus, has led to the emergence of percutaneous catheter based AF ablation. Since its original description in 1998, the AF ablation procedure has evolved considerably.