Innovations and paradigm shifts in atrial fibrillation ablation

Abstract

Treatment of symptomatic atrial fibrillation has seen important changes in the past decades. Advancements have especially been made in the field of non-pharmacological treatment of this disease. Patients in whom a rhythm control strategy is chosen the place of catheter ablation has become more frontline therapy in the past years. The procedure itself has also seen changes in technologies that can be used, either using point-by-point radiofrequency or one of the single-shot techniques. One of the major limitations that remain is that re-do procedures are often necessary due to incomplete pulmonary vein isolation and/or atrial fibrillation being initiated by other mechanisms than pulmonary vein triggers. Therefore, there is further need for developing ablation tools that reproducibly isolate the pulmonary vein transmurally. Furthermore, addressing the underlying conditions before and after catheter ablation has been shown to be of great importance. In this review, we will give an overview of the evolution of catheter ablation, highlight the latest technologies and their future endeavours, and lifestyle modifications are being discussed as part of the catheter ablation strategy.

Robotic magnetic navigation‐guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation when compared to conventional ablation techniques

“…While conventional settings during RF ablation involve applying low power for long times, a new setting based on high power and short duration has recently been suggested as safer and more effective. [33][34][35][36] Overall, high-power short-duration lesions were significantly wider, and of slightly lower or similar depth compared to standard settings. 33 The increased lesion-to-lesion uniformity and linear continuity, given the larger lesion diameter, is most beneficial in establishing permanent PVI.…”

“…While conventional settings during RF ablation involve applying low power for long times, a new setting based on high power and short duration has recently been suggested as safer and more effective 33–36 . Overall, high‐power short‐duration lesions were significantly wider, and of slightly lower or similar depth compared to standard settings 33 .…”

Combined contact force and local impedance dynamics during repeat atrial fibrillation catheter ablation

“…Several experimental and clinical studies have recently been published reporting experiences of combined CF and LI assessment during index AF ablation (Szegedi et al, 2021;Gutbrod et al, 2022;Solimene et al, 2022;Yasumoto et al, Frontiers in Physiology frontiersin.org 2022). Single-shot devices have seen increased usage for index AF ablations in recent years (Mulder et al, 2021). Therefore, the strength of combining CF and LI monitoring may lie in repeat AF and AT procedures: Here, previously conducted pulmonary vein isolation may show reconnection in up to 70% of cases (Hindricks et al, 2020).…”

Preclinical assessment of the feasibility, safety and lesion durability of a novel ‘single-shot’ pulsed field ablation catheter for pulmonary vein isolation

“… 1–8 Among AF ablation approaches, ‘single-shot’ circumferential pulmonary vein (PV) ablation approaches are particularly attractive when compared with the point-by-point approach as it simplifies workflow. 9–13 Thus, single-shot catheters capable of PF delivery can realize such advantages simultaneously making this an attractive approach. We describe, in this preclinical report, an efficacy and safety evaluation of an over-the-wire, expandable lattice-shaped catheter that can achieve rapid, durable thoracic vein isolation with a simple workflow.…”