A critical appraisal of cardiac ablation technology for catheter-based treatment of atrial fibrillation

Abstract

The advent of catheter ablation has revolutionized the treatment of supraventricular cardiac arrhythmias, including in the last few years, atrial fibrillation. The discovery of electrically active sleeves of atrial myocardium extending into the pulmonary veins has led to the development of pulmonary vein ostial ablation, with the aim of electrically isolating or ‘walling-off’ the arrhythmogenic tissue. Despite different innovations, the most commonly used technique is the composite multiple-point ablation lesion created with a fundamentally simple radiofrequency energy-delivering ablation catheter. The high recurrence rate and low efficacy of current ablation procedures may be traced in large part to the inherent variability in individual lesion size with this technology. Arguably, real-time lesion monitoring, optimization and prediction are necessary to achieve significant improvements in efficacy and safety for catheter ablation of atrial fibrillation.