Atrial fibrillation (AF) is a prevalent arrhythmia, while pulmonary vein
isolation (PVI) has become a cornerstone in its treatment. The creation of
durable lesions is crucial for successful and long-lasting PVI, as inconsistent
lesions lead to reconnections and recurrence after ablation. Various approaches
have been developed to assess lesion quality and transmurality
in vivo
,
acting as surrogates for improved lesion creation and long-term outcomes
utilizing radiofrequency (RF) energy. This review manuscript examines the
biophysics of lesion creation and different lesion assessment techniques that can
be used daily in the electrophysiology laboratory when utilizing RF energy. These
methods provide valuable insights into lesion effectiveness, facilitating
optimized ablation procedures and reducing atrial arrhythmia recurrences.
However, each approach has its limitations, and a combination of techniques is
recommended for comprehensive lesion assessment during AF catheter ablation.
Future advancements in imaging techniques, such as magnetic Resonance Imaging (MRI), optical coherence
tomography, and photoacoustic imaging, hold promise in further enhancing lesion
evaluation and guiding treatment strategies.