New Technologies for Catheter Ablation of Atrial Fibrillation
- Edward P. Gerstenfeld MD
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The past decade of ablation for atrial fibrillation (AF) has seen the adaptation of catheters designed for “focal” tachycardias or single pathways to perform wide encirclement of the pulmonary veins (PV). During the next decade, technologies designed specifically for PV isolation will emerge. Each system has its unique attributes. The cryoballoon system offers rapid PV isolation and the promise of enhanced safety, whereas the success rate is likely to be similar to catheter-based approaches. Although preclinical studies do suggest a very low likelihood of left atria-esophageal fistula using this technology, concerns of phrenic nerve damage and a small incidence of PV stenosis need to be addressed. It is likely that use of the larger 28-mm balloon will mitigate these concerns. The cryoballoon is also the first balloon technology to be approved by the US Food and Drug Administration for clinical use, and this may gain the technology an early foothold in the AF ablation market. The laser balloon ablation system is a more time-consuming and technically demanding procedure, and the risk of thrombus formation if ablation is performed in stagnant blood is a concern. However, early studies suggest a high rate of persistent PV isolation, which hopefully will translate into high single-procedure efficacy. The Ablation Frontiers system is the only system currently being developed for more persistent forms of AF. This system offers a rapid approach to PV isolation and left atrial defragmentation. The early results do not demonstrate a success rate better than that described for catheter ablation; however, the results are difficult to compare to standard catheter ablation in this recalcitrant patient group without a prospective randomized study.
- Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66. CrossRef
- Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes NA 3rd, et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Heart Rhythm. 2011;8(1):157–76. These are the current ACC/AHA guidelines for managing AF.
- Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA 2010;303:333–40. CrossRef
- Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi Jr F, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006;354(9):934–41. CrossRef
- Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293:2634–40. CrossRef
- Packer DL, Lee KL, Mark DB, Monahan KH, Hoffmann KL, Hafley GE, et al. Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation - Pilot Trial. J Amer Coll Cardiol 2010; Abstract. The CABANA pilot trial compared catheter ablation and medical management of AF in a small, prospective randomized trial. The larger randomized trial is now underway.
- Packer D, et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front Stop-AF trial. J Amer Coll Cardiol. 2010;Abstract 3015–6. The Stop-AF trial compared cryoballoon ablation to antiarrhythmic therapy for treating AF.
- Reddy VY, Neuzil P, Themistoclakis S, Danik SB, Bonso A, Rossillo A, et al. Visually-guided balloon catheter ablation of atrial fibrillation: experimental feasibility and first-in-human multicenter clinical outcome. Circulation. 2009;120(1):12–20. CrossRef
- Reddy VY, Neuzil P, D’Avila A, Laragy M, Malchano ZJ, Kralovec S, et al. Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation? Hear Rhythm. 2008;5(3):353–60. CrossRef
- Scharf C, Boersma L, Davies W, Kanagaratnam P, Peters NS, Paul V, et al. Ablation of persistent atrial fibrillation using multielectrode catheters and duty-cycled radiofrequency energy. J Am Coll Cardiol. 2009;54(15):1450–6. CrossRef
- New Technologies for Catheter Ablation of Atrial Fibrillation
Current Treatment Options in Cardiovascular Medicine
Volume 13, Issue 5 , pp 393-401
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links
- Author Affiliations
- 1. Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Avenue, MU East 4, Box 1354, San Francisco, CA, 94143, USA