Cardiovascular Pharmacology: Open Access

Catheter ablation of atrial fibrillation: State of the art and next future

International Conference and Expo on Heart and Cardio Care

May 25, 2022 | Webinar

Stefano Nardi

Unicamillus International School of Medicine and Surgery, Rome

Keynote: Cardiovasc Pharm

Abstract:

Background Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and is often associated with high rates of morbidity and mortality. Maintenance of stable sinus rhythm (SR) is the designed target treatment in symptomatic populations, and the continuous development of more efficacy and effective therapeutic approach for treating or, in some ambitious instances, curing with catheter ablation (CA) the human AF has followed a complex path over the time, throughout different techniques has been proposed and applied. At the present, an elevated percentage of patients each year undergo to CA for this arrhythmia and this number continuous to grow-up over the time. It’s clearly evident that different mechanisms exist and often coexists in the same subject that trigger and perpetuate AF and, in this view, substantial progress have been made with the elucidation of the electro-physiologic mechanisms underlined the specific therapeutic success of different catheter based approach. Substrate is important and trigger too, and probably both the mechanisms are involved in the determinism of this arrhythmia. Clinical outcome data based on several randomized controlled trials (RCTs) have clearly demonstrated that pulmonary veins isolation (PVI) provides the most effective treatment option, and support and encourage this approach. Variety sources of energy and different devices have been developed, proposed, applied, and evaluated; then, in this review, I focus on the actual state of the art of CA of AF, principally based on my personal experiences, and describe future perspectives. Recent evidence The weight of evidence supports the idea that CA is a well-established treatment option for patients with symptomatic AF and is more successful at maintaining SR than antiarrhythmic drugs (AADs) alone or in combination with electrical cardio-version (ECV). Large antral pulmonary vein isolation (PVI) as a stand-alone ablation strategy results in beneficial clinical outcomes and is therefore recommended as first-line strategy for both paroxysmal and persistent AF. While radiofrequency based PVI in conjunction with a three-dimensional mapping system has been the “gold standard” option for many years, more recently have emerged different one-shot approaches as alternative strategy, especially in patients with paroxysmal AF, such as a specifically well-designed pulmonary veins ablation catheter (PVAC) that work in combination with a multi-channel duty-cycle phased RF generator, or cryoballoon. Patients with persistent or long-standing persistent AF and with arrhythmia recurrence after previous PVI may benefit from additional ablation strategies, such as substrate modification of various forms or left atrial appendage isolation, even if a large, randomized trial, named STAR-AF II, have denied this claim. New technologies, such as pulsed field energy, and different techniques, such as identification of the AF sources or a merge integration between fluoroscopy and CT scan, maybe can improve the success rates of CA for selected patients and might help to further reduce arrhythmia recurrence. Conclusion PVI is the treatment of choice for symptomatic patients both with paroxysmal and persistent drug-refractory AF. The reconnection of previously isolated pulmonary veins remains the major cause of AF recurrence and new ablation tools, such as single one-shot technique or alternative source of energy, might help to overcome this limitation. Patients with non-paroxysmal AF and with AF recurrence might benefit from alternative ablation strategies, even if the weight of evidence is low. However, further studies are ongoing to improve our knowledge of the underlying mechanisms of AF and to obtain long-term clinical outcomes on new ablation techniques.

Biography :

Stefano is a Medical Doctor with specialization in Cardiology and in Arrhythmia treatment. Is the Director of Arrhythmia, EP Center and Cardiac Pacing Unit of Heart Department of Pineta Grande Hospital. Moreover, is Professor of Medicine at Unicamillus International School of Medicine and Surgery. He has published more than 100 papers/ablstact in reputed journals, such as NEJM, Circulation, and JACC etc