Atrial fibrillation (AF) is the most common arrhythmia. For many years, treatment was predominantly pharmacological. The identification of signals from the pulmonary veins as critical to AF in many patients led to catheter ablation targeting these signals. Catheter ablation is more effective than antiarrhythmic drugs at restoring sinus rhythm, and may improve mortality, morbidity and quality of life in patients with symptomatic AF. There is evidence to suggest that catheter ablation would be even more beneficial if undertaken earlier in the disease process. Cost effectiveness of catheter ablation remains under assessment, but it does meet the NICE definition of cost efficacy and the figure improves as stroke risk rises. It is true that long-term data are lacking. However, until results of current long-term studies become available, ablation will continue to be reserved predominantly for patients with drug-refractory, symptomatic AF.