Moderne Technologien in der Ablation des Vorhofflimmerns

Abstract

Catheter ablation for atrial fibrillation has become an accepted therapy. The arrhythmia affects around 6% of the population over the age of 65 years. Electrical isolation of the pulmonary veins from the left atrium is the central strategy in catheter ablation for paroxysmal atrial fibrillation. However, procedural outcomes and efficacy using sequential “point-by-point” radiofrequency lesion creation with a conventional ablation catheter are operator-dependent and time-consuming. Moreover, re-conduction across an initially complete lesion leads to recovery in electrical isolation of the pulmonary vein and recurrence of atrial fibrillation. New energy sources such as cryothermia, ultrasound and laser have emerged and are currently under investigation. These apply “single-shot” lesions via balloon mounted catheters positioned at the pulmonary vein ostia. Other new tools, such as magnetic navigation system and electromechanical robotic system, allow complete remote controlled mapping and ablation by combining three dimensional electroanatomical mapping. All these tools and technologies have to prove their effectiveness and safety