Innovative tools for atrial fibrillation ablation

ABSTRACT

Introduction

Catheter ablation (CA) for atrial fibrillation (AF) is an effective treatment option with encouraging clinical outcome data. Further improvement of catheter technologies is desirable, in particular for patients with persistent and long-standing persistent AF.

The aim of this review is to provide an overview of novel ablation tools in AF-ablation.

Areas covered

The most widely used ablation tool still is the single-tip catheter for radiofrequency (RF) ablation. Contact-force (CF) catheters and the introduction of individualized ablation protocols may overcome limitations of single-tip RF-based ablation. Furthermore, balloon-based pulmonary vein isolation (PVI) – first and foremost the cryoballoon (CB) – based ablation – moved into the foreground especially for the treatment of paroxysmal AF, because of its ease of use and proven safety. Upcoming RF balloon technologies are also promising. Moreover, new mapping and imaging technologies might help to identify non-PV-triggers in patients with arrhythmia recurrence and may have the potential to enable real-time therapy assessment.

Expert Opinion

New ablation tools such as CF-sensing catheters or novel balloon-devices could help to overcome the major limitation of PV-reconnection and lead to improved outcomes. Moreover, novel mapping tools to identify extra-PV-triggers may improve ablation success in patients with persistent and long-standing persistent AF.

KEYWORDS:

• Catheter ablation
• atrial fibrillation
• new mapping techniques
• novel ablation tools

Article highlights

1. While RF-based PVI was considered the ‘gold standard’ for the treatment of atrial AF for a long time, the CB has turned out to be a common alternative tool for AF ablation.

2. PV reconnection still remains the major limitation regarding the longterm efficacy of catheter ablation and novel ablation technologies are mandatory to overcome this drawback.

3. The introduction of CF-sensing catheters and the LSI and AI as well as novel protocols such as HPSD denotes an important step towards an improvement of sufficient lesion formation during RF-based ablation.

4. Novel balloon-based ablation systems have emerged to further improve the procedural and clinical outcome after AF ablation. These include, among others, the CB, the endoscopic laserballoon, and soon an RF-based ablation balloon.

5. Novel mapping strategies to identify extra-pulmonary-vein-triggers are warranted to improve ablation success especially in patients with persistent and long-standing persistent AF.

Declaration of interest

A Rillig has received travel grants from Biosense Webster, Medtronic, Ablamap CardioFocus, and EPD and consultant or lecture fees from Medtronic, EPD, Böhringer Ingelheim, Cardiofocus, and Biosense webster. A Metzner has received speaker’s honoraria/travel grants from Medtronic, Biosense Webster, & CardioFocus. 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.