Various approaches for catheter ablation of focal initiators of atrial fibrillation or the substrate for maintaining atrial fibrillation have evolved over the past 5 years. Despite these advances, there are still a large number of unresolved issues regarding the efficacy and safety of these procedures as well as optimal patient selection for the different approaches. These uncertainties raise questions about the applicability at the present time of atrial fibrillation as front-line therapy within the community.