Atrial fibrillation ablation strategies and technologies: past, present, and future
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REVIEW
Atrial fibrillation ablation strategies and technologies: past, present, and future Thomas J. Buist1 · Douglas P. Zipes2 · Arif Elvan1 Received: 11 February 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Catheter ablation is an established treatment option for atrial fibrillation (AF), and pulmonary vein isolation (PVI) has become the gold standard in AF ablation. AF recurrence after PVI remains an important clinical problem. Recovery of conduction from the pulmonary veins (PVs) is considered the dominant mechanism for AF recurrence in paroxysmal AF. However, the underlying mechanism of AF recurrence after PVI is more complex in patients with persistent and longstanding persistent AF. Different ablation technologies and energy sources have been developed aimed at improving lesion quality and durability with an acceptable safety profile. Novel technologies are under evaluation which have a great potential to produce permanent PVI after a single ablation procedure. However, clinical value of these novel devices needs to be tested in adequately powered randomized controlled trials. In this article, we review the history of catheter ablation for AF and discuss the present and future ablation technologies. Keywords Atrial fibrillation · Ablation · Ablation technologies · Electrophysiology · Catheter ablation · Ablation techniques
Introduction Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia [1] and is associated with reduced quality of life [2], increased mortality [3] and morbidity, including enhanced risk of stroke [4], heart failure [5], and repeated hospitalizations [6]. Due to its significant impact on cardiovascular morbidity and mortality, researchers have sought ways to successfully treat and even cure some types of AF. Over the past decades, percutaneous catheter ablation (CA) has become an important AF treatment modality to restore and maintain sinus rhythm. Pulmonary vein isolation (PVI) is now considered the cornerstone of catheter-based treatment for paroxysmal and early persistent AF [7, 8]. Since the introduction of CA, major advances have been made. Different ablation technologies and energy sources have been designed and the search for improving ablation safety and * Thomas J. Buist [email protected] 1
Heart Centre, Dept of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 Zwolle, The Netherlands
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
2
clinical outcome continues. This article outlines the history and evolution of CA, reviews the currently available AF ablation technologies, and provides a glimpse into future ablation techniques.
History of catheter ablation The first intra-cardiac use of catheters was described in the 1960s, where the application was limited to signal recording and cardiac stimulation. One of the earliest reports of catheter use is a study performed by Durrer et al. in which application of intracardiac electrical pulses and s
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