Faster, safer and better catheter ablation?

Undoubtedly the pace at which we are living increases step by step on a daily basis. Since this is a gradual process in general, this may go unnoticed to some, but the implications on healthcare are not to be taken too lightly. Interventional electrophysiology as a distinct entity is a relatively young discipline. It has gone through several groundbreaking changes in a short time span. Although the first measurements of cellular currents date from the late 1800s, in general the birth of invasive clinical electrophysiology, associated with the use of programmed electrical cardiac stimulation combined with intracardiac activation mapping by the groups of Durrer and Coumel, is said to be no earlier than 1967. After having been used for several years as a diagnostic tool to evaluate the effect of anti-arrhythmic drugs, the therapeutic options of electrophysiology emerged in the early 1980s with the ‘shock’ ablation of the His bundle. At roughly the same time the pacing branch of electrophysiology experienced a comparable ‘shock’ with the introduction of the first implantable automatic defibrillator. In the last decade, there has been a relentless innovation in the field of electrophysiology. The invasive electrophysiological armamentarium now consists of numerous diagnostic tools, multiple implantable devices aiming to pace, defibrillate or resynchronize the heart and a continuously growing number of manually and remotely navigated ablation catheters in various shapes and sizes

Cryoablation: how to improve results in atrioventricular nodal reentrant tachycardia ablation?

Ablation for atrioventricular nodal reentry tachycardia is very effective, with a potential for damage to the normal conduction system. Cryoablation is an alternative, as it allows cryomapping, which permits assessment of slow pathway elimination at innocent freezing temperatures, avoiding permanent damage to the normal conduction system. It is associated with shorter radiation times and the absence of heart block in all published data. We discuss in this overview different approaches of cryoenergy delivery (focusing on spot catheter ablation), and how lesion formation is influenced by catheter tip size, application duration, and freezing rate. Some advantages of cryoenergy are explained. Whether these features also apply for an approach with a cryoballoon, e.g. for atrial fibrillation is unclear

Retrograde access of the left atrium for pulmonary vein isolation using magnetic navigation after closure of an atrial septum defect

Transseptal puncture is the most commonly used technique to perform electrophysiological procedures in the left atrium. This case report describes a pulmonary vein isolation in a patient with a paroxysmal atrial fibrillation, complicated by the presence of an oversized Amplatzer device (AGA Medical Corp., Golden Valley, MN). A retrograde approach using the magnetic navigation system (Niobe, Stereotaxis Inc., St Louis, USA) was performed, and showed to provide a feasible, safe and successful alternative for catheter ablation of cardiac arrhythmias in patients in whom the classic transseptal approach is impossible

Safety and feasibility of single-catheter ablation using remote magnetic navigation for treatment of slow-fast atrioventricular nodal reentrant tachycardia compared to conventional ablation strategies

Objective Ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) is a highly effective procedure both with radiofrequency (RF) and cryoenergy (CE). Conventionally, it requires several diagnostic catheters and hospital admission. This study assessed the safety and efficacy of a highly simplified approach using the magnetic navigation system (MNS) compared to CE and manual RF ablation (MAN). Methods and results In the MNS group a single magnetic-guided quadripolar catheter was inserted through the internal jugular vein to perform ablation. In the CE group cryomapping preceded ablation and for MAN procedures conventional ablation was performed. The following parameters were analysed: success- and recurrence rate, procedure-, fluoroscopy- and total application time. In total 69 eligible patients were treated with MNS (n = 26), CE (n = 25) and MAN (