Pulmonary vein isolation (PVI) is the cornerstone of rhythm-control therapy for atrial fibrillation (AF). A few years ago, contact force-sensing ablation catheters (CFSAC) were introduced. Nowadays the use of CFSAC became a part of the everyday practice. The durability of PVI depends much on the accurate lesion creation. The recently developed techniques (ablation index, CLOSE protocol) may facilitate the procedure in terms of achieving durable PVI which has already been confirmed by randomized trials. In this chapter, we would like to introduce the theoretical background of PVI and compare different techniques (radiofrequency point-by-point, cryoballoon, additional ablation lines for persistent AF) with special highlight on the importance of durable PVI.
Part of the book: Epidemiology and Treatment of Atrial Fibrillation
Catheter ablation is the cornerstone of the rhythm control treatment of atrial fibrillation (AF). During this procedure, creating a contiguous and durable lesion set is essential to achieve good long-term results. Radiofrequency lesions are created in two phases: resistive and conductive heating. The ablation catheters and the generators have undergone impressive technical developments to enable homogenous and good-quality lesion creation. Despite recent years’ achievements, the durable isolation of the pulmonary veins remains a challenge. These days, intensive research aims to evaluate the role of high-power radiofrequency applications in the treatment of patients with cardiac arrhythmias. The use of high-power, short-duration applications might result in a uniform, transmural lesion set. It is associated with shorter procedure time, shorter left atrial, and fluoroscopy time than low-power ablation. This technique was also associated with a better clinical outcome, possibly due to the better durability of lesions. Multiple clinical studies have proven the safety and efficacy of high-power, short-duration PVI.
Part of the book: Cardiac Rhythm Management - Pacing, Ablation, Devices