New Technologies In Atrial Fibrillation Ablation

Introduction Atrial fibrillation(AF) remains the most common sustained arrhythmia in the United States affecting greater than 3 million individuals, a number likely to rise dramatically by 2015.1 AF is associated with symptoms such as a palpitations, lightheadedness, fatigue, and may precipitate heart failure. In addition, it has been associated with an increased risk for stroke, increased hospitalizations, and increased mortality.2 For many years, anti-arrhythmic medications were the only options for the treatment of patients with symptomatic AF. Such medications are associated with relatively poor long-term efficacy profiles as well as many known toxicities.3 In 1998, Haissaguerre and colleagues made the observation that triggers from within the pulmonary veins were often the precipitating event in AF initiation thus providing a potential target for ablation.4 Initial strategies of AF ablation were surgical and while fairly successful were also associated with significant morbidity.5,6 Building off the experience of the COX MAZE procedure, catheter ablation procedures were developed to isolate the pulmonary veins from the left atrium via circular radiofrequency ablations surrounding the pulmonary veins. Over the last decade, catheter ablation has become an effective tool in the management of symptomatic, drug refractory AF demonstrating superior results at one year compared to anti-arrhythmic medications alone.7 Currently, radiofrequency energy is the main energy source for pulmonary vein isolation(PVI) procedures. PVI currently involves either dragging or point by point