Interventional treatment of atrial fibrillation – contemporary methods and perspectives

Abstract

Atrial fibrillation (AF) is estimated to affect nearly 3 million people around the world. It is the most common arrhythmia and its incidence increases with age. Catheter ablation is an interventional procedure performed to reduce the patient’s AF burden when pharmacotherapy did not succeed in relieving the patient’s symptoms. The ablation is most effective in paroxysmal AF; however, many techniques are being developed to make this procedure more eligible for patients with persistent arrhythmia. The most common AF ablation technique involves separating electric activity of the pulmonary veins from the left atrium. Over recent years, many novel and promising techniques were developed (e.g., balloon cryoablation, circular catheter ablation, laser ablation, robotic navigation, etc.), which may further improve AF ablation efficacy.

Keywords::

• arrhythmia
• atrial fibrillation
• catheter ablation
• cryoablation
• interventional treatment
• laser ablation
• radiofrequency ablation

Financial & competing interests disclosure

K Kaczmarek has received a research grant from Biosense Webster and is on the advisory board for Boston Scientific. L Szumowski has received research grants from Biosense Webster, Biotronik and Medtronic. P Ptaszynski has received research grants from Biosense Webster and Medtronic, as well as a research fellowship from St Jude Medical. He is also on the advisory board for Biosense Webster. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Atrial fibrillation (AF) is the most common sustained arrhythmia and a major cause of stroke.

• Catheter ablation is a safe and efficient method of interventional treatment of AF.

• Ablation of paroxysmal AF generally focuses on electrical isolation of pulmonary veins from left atrium.

• New methods of ‘single-shot’ pulmonary veins isolation – balloon cryoablation, circular radiofrequency catheter, visually guided laser balloon ablation are promising and help to make the procedure more efficient, quicker and easier.

• Robotic navigation systems provide better catheter stability and allow the physician to move away from x-ray source.

• Ablation of autonomic ganglia of left atrium added to the pulmonary vein isolation increases the procedure efficacy.

• Catheter ablation in persistent and long-standing AF is still not as effective as in the paroxysmal AF.

• Complex fractioned electrograms ablation, ganglionated plexi ablation and focal impulse and rotor modulation are ‘gleam of hope’ for patients with persistent and long-standing AF.

• The next few years will provide us with the results of many important trials that will define the direction of development of AF ablation techniques.

Notes