Technical principles of ablation therapy

Abstract

Catheter ablation is astandard procedure in modern cardiology. It can significantly improve the quality of life and life expectancy of cardiac arrhythmia patients. Besides cardiac mapping, ablation itself is afundamental step tosuccessfully treat cardiac arrhythmias. There are various ablation technologies at hand: In traditional radiofrequency (RF) ablation, electrical current flow generates coagulation necrosis. When understanding the biophysical principles of RF ablation, the investigator is capable to adapt lesion geometry and size to the requirements of the procedure and vary them individually. In addition, lesion metric indices evaluate and integrate important parameters such as power, duration, impedance and contact force to standardize and control RF lesions. Cryoablation induces ice crystals within myocardial tissue, which lead to destruction and electrical scarring of the treated tissue. Histologically, cryolesions are well-delineated with preserved tissue architecture and intact endocardium. Pulsed field ablation (PFA) is anovel rising technology, particularly used for pulmonary vein isolation. In contrast to classic thermal technologies (RF and cryoablation), PFA uses pulsed electrical fields to electroporate cardiac tissue and thereby creates damage on acellular level only.