Lemery R.,Institute Of Cardiologie Dottawa
Archives of Cardiovascular Diseases Supplements | Year: 2010
Ablation of atrial fibrillation continues to evolve, with a growing number of patients having undergone this intervention. The software and the techniques for ablation have improved, and the patients requiring this procedure have increased in age, or undergo multiple interventions, or have persistent atrial fibrillation. For patients with paroxysmal atrial fibrillation, the recent use of balloon catheters or catheters with circumferential forms to isolate the pulmonary veins could possibly decrease the duration of procedures. For patients with persistent atrial fibrillation, the ablation technique remains complex and uncertain. In general, these patients require extensive ablation, the interpretation of complex fractionated atrial electrograms is difficult, and an atrial tachycardia is usually required to emerge as an initial end-point for elimination of atrial fibrillation. New software will soon be available to determine the extent of contact force of the ablation catheter with the endocardium. This could improve the effectiveness of ablation, while decreasing the risks. Indeed, use of manual or robotic catheters during ablation has shown significant variations in contact force. Thus, it would appear useful to measure the extent of pressure applied to the catheter, and to adjust the delivered energy accordingly. As for magnetic mapping, with ablation guided remotely by 0.1 Tesla of force, the technique remains extremely precise and safe, but the costs and duration of interventions have limited its use. © 2010 Elsevier Masson SAS.