It is more than a decade since contact force sensing catheters have been used in man and as the technology and availability of these catheters has improved, they are now becoming standard of care. As our use of these catheters has increased, the focus has shifted from trying to understand the mechanisms underlying persistent AF to creating stable lesion sets.
Although some users have been performing AF ablation at 50W for many years, the majority of electrophysiologists have been using 25-30W, now classified as low power. With the use of contact force ablation catheters and algorithms to help standardise both individual lesions and contiguous lesion delivery, there is now widespread interest in high power, short duration lesion delivery. How high the power delivery can go to and how short lesion delivery needs to be, is yet to be clearly defined. This is an area of intense scientific interest and there are a number of manuscripts featured on the website which I urge you to read, these have the power to change our clinical practice, and allow more patients to be treated.
As our lesion sets become stable, the question about, 'what to do when a patient returns with AF but with isolated pulmonary veins?' will become more pressing. Prior to the use of contact force catheters and lesion tracking, pulmonary vein reconnection was common, and repeat pulmonary vein isolation was reasonable. As the balance changes with more patients who do have recurrences having isolated pulmonary veins, the search for additional sources will intensify. Previous studies on the posterior wall and Marshall connections have been limited by our ablation tools, and the ability to achive durable lesions. With current technology and alcohol based ablation, this is no longer the case and there is increasing evidence to suggest that these structures are critical for ablation success in selected patients.
I hope you enjoy the featured articles in this section and continue to treat patients successfully.
Dr Matt Wright
08 June 2018
CLOSE Protocol: Management of Paroxysmal AF using CARTO VISITAG™ Module with Ablation Index - Dr Mattias Duytschaever08 June 2018
HRS 2018: Catheter ablation vs. anti-arrhythmic drug therapy for atrial fibrillation - Dr Matthew Wright31 May 2018
18 May 2018
16 May 2018
24 April 2018
Thiyagarajah A, Kadhim K, Lau DH, et al. Circ Arrhythm Electrophysiol 2019;12:e007005.
Hoshiyama T, Fukushima H, Noda K, et al. Circ Arrhythm Electrophysiol 2019;12:e007320.
Comparison Between Contact Force Monitoring and Unipolar Signal Modification as a Guide for Catheter Ablation of Atrial FibrillationEjima K, Kato K, Okada A, et al. Circ Arrhythm Electrophysiol 2019;12:e007311.
Long-term outcomes after low power, slower movement versus high power, faster movement irrigated-tip catheter ablation for atrial fibrillationBunch TJ, May HT, Bair TL, et al. Heart Rhythm 2019; epub ahead of press.