Catheter Ablation of Cardiac Arrhythmias: Past, Present and Future

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Electrophysiology and Cardiovascular Physiology".

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 1617

Special Issue Editor


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Guest Editor
Department of Cardiology, Université Catholique de Louvain, CHU UCL Namur Site Godinne, 5530 Yvoir, Belgium
Interests: cardiac electrophysiology and ablation; innovative cardiac therapies; atrial fibrillation; ventricular arrhythmias; supraventricular arrhythmias; pathophysiology; anticoagulation; autonomic nervous system; neurocardiology; sudden cardiac death; reduction in the use of ionizing radiation; PM; ICD

Special Issue Information

Dear Colleagues,

This Special Issue aims to provide a comprehensive overview of technological advances in electrophysiology, focusing on understanding signal analysis, the energy sources used to treat arrhythmias and the need to minimize the use of ionizing radiation. By linking historical background, current standards, and emerging trends, this issue provides an educational resource for electrophysiologists and early-career cardiologists. Rapid advances in diagnostic and treatment capabilities, such as new catheters (including multi-electrode and micro-electrode), signal analysis algorithms and 3D reconstructions of the cardiac cavity, have revolutionized the field. However, the complexity of these advances requires a critical understanding of their foundations, mechanisms, and implications. This issue will cover topics such as electrogram analysis, the impact of electrode size and contact on signal quality, high-resolution mapping (when really needed) and automatic annotation methods. It will also explore the evolution of the various energy sources used in the treatment of arrhythmias, such as DC shocks, radiofrequency ablation, cryoablation and electroporation, focusing on the potential of electroporation as a controlled DC shock and a possible reference energy in the near future. This Special Issue will also devote a section to examining strategies for minimizing exposure to ionizing radiation, addressing the risks to patients and medical staff.

By emphasizing the importance of understanding past technologies to grasp the potential of future innovations, this Special Issue aims to ensure the advancement of electrophysiology while fostering an environment of safety and innovation through knowledge and understanding.

Prof. Dr. Olivier Xhaet
Guest Editor

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Keywords

  • electrophysiology
  • diagnostic catheters
  • basic of signal analysis
  • automatic signal analysis
  • arrhythmia treatment
  • ionizing radiation reduction
  • 3D cardiac reconstruction
  • AI in signal interpretation
  • sources of energy
  • electroporation

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Published Papers (1 paper)

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Research

10 pages, 1511 KiB  
Article
High-Power Short-Duration Posterior Wall Isolation in Addition to Pulmonary Vein Isolation in Persistent Atrial Fibrillation Ablation Using the New TactiFlex™ Ablation Catheter
by Sergio Conti, Francesco Sabatino, Giulia Randazzo, Giuliano Ferrara, Antonio Cascino and Giuseppe Sgarito
J. Cardiovasc. Dev. Dis. 2024, 11(9), 294; https://doi.org/10.3390/jcdd11090294 - 20 Sep 2024
Viewed by 1225
Abstract
Background: The TactiFlex™ ablation catheter, Sensor Enabled™ (Abbott, Minneapolis, MN, USA), is an open-irrigation radiofrequency (RF) ablation catheter with flexible tip technology. This catheter delivers high-power short-duration (HPSD) RF ablations and has been adopted for atrial fibrillation (AF) ablation. HPSD is well-established not [...] Read more.
Background: The TactiFlex™ ablation catheter, Sensor Enabled™ (Abbott, Minneapolis, MN, USA), is an open-irrigation radiofrequency (RF) ablation catheter with flexible tip technology. This catheter delivers high-power short-duration (HPSD) RF ablations and has been adopted for atrial fibrillation (AF) ablation. HPSD is well-established not only in pulmonary vein isolation (PVI) but also when targeting extra-pulmonary vein (PV) targets. This study aims to determine the safety, effectiveness, and acute outcomes of PVI plus posterior wall isolation (PWI) in patients with persistent atrial fibrillation (Pe-AF) using HPSD and the TactiFlex™ ablation catheter. Methods: Consecutive patients who underwent the ablation of Pe-AF in our centre between February 2023 and February 2024 were prospectively enrolled in the study. All patients underwent PVI plus PWI using TactiFlex™ and the HPSD strategy. The RF parameters were 50 W on all the PV segments and the roof, and within the posterior wall (PW). Left atrial mapping was performed with the EnSite X mapping system and the high-density multipolar Advisor HD Grid, Sensor Enabled™ mapping catheter. We compared the procedural data using HPSD with TactiFlex™ (n = 52) vs. a historical cohort of patients who underwent PVI plus PWI using HPSD settings and the TactiCath ablation catheter (n = 84). Results: Fifty-two consecutive patients were included in the study. PVI and PWI were achieved in all patients in the TactiFlex™ group. First-pass PVI was achieved in 97.9% of PVs (n = 195/199). PWI was obtained in all cases by delivering extensive RF lesions within the PW. There were no significant differences compared to the TactiCath group: first-pass PVI was achieved in 96.3% of PVs (n = 319/331). Adenosine administration revealed PV reconnection in 5.7% of patients, and two reconnections of the PW were documented. Procedure and RF time were significantly shorter in the TactiFlex™ group compared to the TactiCath group, 73.1 ± 12.6 vs. 98.5 ± 16.3 min, and 11.3 ± 1.5 vs. 23.5 ± 3.6 min, respectively, p < 0.001. The fluoroscopy time was comparable between both groups. No intraprocedural and periprocedural complications related to the ablation catheter were observed. Patients had an implantable loop recorder before discharge. At the 6-month follow-up, 76.8% of patients remained free from atrial arrhythmia, with no significant differences between groups. Conclusions: HPSD PVI plus PWI using the TactiFlex™ ablation catheter is effective and safe. Compared to a control group, the use of TactiFlex™ to perform HPSD PVI plus PWI is associated with a similar effectiveness but with a significantly shorter procedural and RF time. Full article
(This article belongs to the Special Issue Catheter Ablation of Cardiac Arrhythmias: Past, Present and Future)
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