Progress in atrial fibrillation ablation during 25 years of Europace journal

Abstract

The first edition of Europace journal in 1999 came right around the time of the landmark publication of the electrophysiologists from Bordeaux, establishing how elimination of ectopic activity from the pulmonary veins (PVs) resulted in a marked reduction of atrial fibrillation (AF). The past 25 years have seen an incredible surge in scientific interest to develop new catheters and energy sources to optimize durability and safety of ablation, as well as study the mechanisms for AF and devise ablation strategies. While ablation in the beginning was performed with classic 4 mm tip catheters that emitted radiofrequency (RF) energy to create tissue lesions, this evolved to using irrigation and contact force (CF) measurement while increasing power. Also, so-called single-shot devices were developed with balloons and arrays to create larger contiguous lesions, and energy sources changed from RF current to cryogenic ablation and more recently pulsed field ablation with electrical current. Although PV ablation has remained the basis for every AF ablation, it was soon recognized that this was not enough to cure all patients, especially those with non-paroxysmal AF. Standardized approaches for additional ablation targets have been used but have not been satisfactory in all patients so far. This led to highly technical mapping systems that are meant to unravel the drivers for the maintenance of AF. In the following sections, the development of energies, strategies, and tools is described with a focus on the contribution of Europace to publish the outcomes of studies that were done during the past 25 years.

Dual energy for pulmonary vein isolation using dual-energy focal ablation technology integrated with a three-dimensional mapping system: SmartfIRE 3-month results

“… 20 , 24 The combined use of PF and RF has resulted in a significant reduction of the ablation time with respect to prior literature describing RF PVI using the CLOSE protocol. 36 This can be expected to further improve with workflow standardization, similar to the experience with index-guided RF ablation, 6 , 34 , 35 and should be evaluated in a larger population in a real-world setting. 20 , 23 , 24 About 15% of patients (20/137) successfully underwent ablation procedures without general anaesthesia.…”

“… 2–4 Adoption of these workflows in the real world has shown the reproducibility of outcomes, along with techniques to further minimize fluoroscopy in procedures. 5 , 6 …”

Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial

“…Despite the power setting of 35 W is currently widely used in numerous centres, 37 the CLOSE approach has evolved to a faster PVI strategy using 45/50 W, which could also be equally safe; however, concerns about safety remain for high-power settings using catheters not specifically designed for that purpose. 22 , 38–41 A main limitation of the study is the single-centre design which does not allow the generalizability of the results.…”

Application of a circular-shaped pulsed field ablation catheter with magnetic sensors for pulmonary vein isolation: a multi-centre clinical study report

“…In recent years, PFA, a newly emerging method, has been introduced for PVI, showing encouraging prospects. 6 …”