Duty-cycled radiofrequency pulmonary vein isolation: an epic journey between enthusiasm and aversion

Abstract

This editorial refers to ‘European survey on efficacy and safety of duty-cycled radiofrequency ablation for atrial fibrillation’ by C. Scharf et al ., doi:10.1093/europace/eus188 Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is predicted to increase dramatically in the next decades. However, drug therapy remains limited: antiarrhythmic drugs carry a heavy charge of adverse effects and rate control drugs are often unsatisfactory. The development of ablative approaches to treat this arrhythmia has opened a new world of opportunities. The number of AF procedures has quickly grown; clinical demand is big. Nevertheless, classical approaches, such as circumferential three-dimensionally (3D) guided pulmonary vein isolation (PVI), remain cumbersome. They require expensive equipment, advanced expertise and are often time-consuming. In order to address these issues, new technologies have been tailored to quickly isolate the pulmonary veins. Two of these techniques have made it to the wide market: the cryoballoon and the multipolar phased-radiofrequency (RF) pulmonary vein ablation catheter (PVAC®). Since its appearance just 4 years ago, multipolar phased RF provided the most promising data. The first publications from single centres,1–4 including a total of 309 patients, reported both short procedure (ranging from impressive 81 ± 13 to 139 ± 38 min) and short fluoroscopy time (ranging from 17 ± 12 to …