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State-of-the-art and emerging technologies for atrial fibrillation ablation

Nature Reviews Cardiology volume 7, pages 129–138 (2010)Cite this article

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Abstract

Catheter ablation is an important treatment modality for patients with atrial fibrillation (AF). Although the superiority of catheter ablation over antiarrhythmic drug therapy has been demonstrated in middle-aged patients with paroxysmal AF, the role the procedure in other patient subgroups—particularly those with long-standing persistent AF—has not been well defined. Furthermore, although AF ablation can be performed with reasonable efficacy and safety by experienced operators, long-term success rates for single procedures are suboptimal. Fortunately, extensive ongoing research will improve our understanding of the mechanisms of AF, and considerable funds are being invested in developing new ablation technologies to improve patient outcomes. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, and speed, catheters designed to deliver radiofrequency energy with improved precision, robotic systems to address the technological demands of the procedure, improved imaging and electrical mapping systems, and MRI-guided ablation strategies. The tools, technologies, and techniques that will ultimately stand the test of time and become the standard approach to AF ablation in the future remain unclear. However, technological advances are sure to result in the necessary improvements in the safety and efficacy of AF ablation procedures.

Key Points

  • Catheter ablation is a commonly performed procedure for the treatment of atrial fibrillation (AF)

  • Electrical isolation of the pulmonary veins is the cornerstone of most AF ablation procedures

  • The use of an irrigated ablation catheter, in conjunction with an electroanatomic mapping system, is currently the most common approach to AF ablation

  • New technologies and tools are being developed to make catheter ablation of AF safer and more effective, and to decrease the time and technical skill required to perform the procedure

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Figure 1: The anatomical and arrhythmic mechanisms of atrial fibrillation.
Figure 2: Schematic of common lesion sets employed in atrial fibrillation ablation.
Figure 3: Complex fractionated atrial electrograms.
Figure 4: Occlusion of the right superior pulmonary vein with the Arctic Front® (Medtronic CryoCath LP Ltd, Chemin Ste-Marie Kirkland, QC) cryoballoon catheter (arrow).
Figure 5: The Ablation Frontiers® (Carlsbad, CA) pulmonary vein ablation catheter (PVAC).
Figure 6: High-density Mesh ablator (Bard Electrophysiology, Lowell, MA) is built around a Mesh geometry that optimizes contact and signal quality without obstructing blood flow.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Carnegie 530, 600 North Wolfe Street, Baltimore, 21287, MD, USA

    Jane Dewire & Hugh Calkins

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  1. Jane Dewire
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Correspondence to Hugh Calkins.

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Competing interests

H. Calkins has acted as a consultant for Ablation Frontiers, Biosense Webster, Medtronic, and Sanofi-Aventis and has received research support from Biosense Webster. J. Dewire declares no competing interests.

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Dewire, J., Calkins, H. State-of-the-art and emerging technologies for atrial fibrillation ablation. Nat Rev Cardiol 7, 129–138 (2010). https://doi.org/10.1038/nrcardio.2009.232

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