Catheter Ablation of Atrial Fibrillation: A Review of the Current Status and Future Directions

Abstract

Atrial fibrillation (AF) is one of the most common arrhythmias encountered in clinical practice today. Over the last 20 years, the frequency of use of catheter ablation to treat AF has grown, commensurate with the rise in arrhythmia burden and via a number of technical advancements. These developments can be divided into new techniques for myocardial ablation, improvements in the understanding of AF trigger mechanisms, and advancements in atrial mapping. Progress in these fields has led to a fundamental change in daily practice, and has contributed to a rise, for ablation, from a procedure performed infrequently at select centers to one that is commonplace worldwide. In this article, the data and methods leading to this fundamental change will be presented and discussed.

Comparing radiofrequency and cryoballoon technology for the ablation of atrial fibrillation

“…The irrigation can lower the catheter tip to tissue interphase temperature and increase the resistive heating capability, hence creating a deeper lesion. The irrigation also serves as a mean of preventing large coagulum formation [6]. Later generations of irrigated catheter tips prevented fluid overload in patients undergoing long procedures; however, this risk is still present in patients with conditions such as congestive heart failure [7].…”

“…Despite reduction in overheating, a significant challenge remains in properly monitoring tissue temperature during ablation. No current method has been accepted or approved for use during radiofrequency ablation [6].…”

Radiofrequency Lesion Quality Markers: Current State of Knowledge

“…Solid-tip 4-10 mm catheters soon evolved into irrigated catheters, which permit higher power applications while protecting the tissue in contact with the catheter tip from overheating. 2 Contact force (CF) sensing catheters were developed more than a decade ago and provide feedback on the quantity and direction of force the operator is applying to the tissue. 2 More recently, mini-and micro-electrodes that provide higher fidelity signals and can evaluate changes in electrograms while ablating have been incorporated in the tips of ablation catheters, as have thermocouples that accurately measure tissue temperature at the catheter tip even in the context of irrigation.…”