Catheter ablation: Developments and choice of technique

This article was originally published here

Herzschrittmacherther Elektrophysiol. 2022 Feb 18. doi: 10.1007/s00399-022-00843-1. Online ahead of print.

ABSTRACT

Atrial fibrillation (AF) is the most common arrhythmia and an important risk factor for the occurrence of cardiovascular events. According to current guidelines, rhythm control therapy is only recommended for symptomatic AF. Even in symptomatic AF, there is still only a Class IIa recommendation for catheter ablation as initial therapy in paroxysmal AF. Meanwhile, current studies have shown an advantage of early rhythm control over rate control, as well as an advantage of catheter ablation over antiarrhythmic therapy (AAD). The gold standard of catheter ablation for the treatment of AF is pulmonary vein isolation, which was primarily based on radiofrequency in the past. However, cryoablation as a first-line treatment for paroxysmal AF is gaining more and more importance, as the latest studies have shown shorter procedure times, lower reoperation rates and improved quality of life after the procedure. cryoablation. Nevertheless, using these standard techniques, the risk of adverse events is always given through collateral damage. High-power short-duration ablation in the field is currently the subject of ongoing AF research, which describes radiofrequency ablation with higher energy levels, given over a shorter duration, with a rate lower consecutive recidivism as well as a procedural time. Newer ablation techniques also include pulsed-field ablation, which allows ablation by very rapid delivery of electrical pulses and causes isolated damage to myocardial cells without collateral damage. This promising technique has passed efficacy and safety tests in preclinical studies. To validate this technique, further randomized trials are needed.

PMID:35182208 | DO I:10.1007/s00399-022-00843-1

Martin E. Berry