Catheter Ablation Increases A-Fib  Recoveries –  Biosense Webster

     Research continues into new ways of preventing and curing A-Fib, boosted  by ever-increasing new      technologies. Catheter ablation has become a  mainstream treatment for the disease due to greater      technological  accuracy.

    It is widely recognised that the impact of Atrial Fibrillation (A-Fib) is not only responsible for significant      cardiovascular and cerebrovascular morbidity and mortality, but is also placing severe strain on      healthcare      resources.

     Largely due to the ageing population, the prevalence of A-Fib is expected to at least double over the next      decades. Almost four and a half million people are affected by A-Fib in Europe alone, among a population      of 426 million. According to current population levels, more than ten million individuals will be expected to      have the disease by 2050.

     One of the key clinical issues in A-Fib is the difficulty in effectively managing the disease, either in terms of      stroke prevention or through treatment to reduce the condition. Fortunately, advances in understanding      some of the causes of A-Fib mean that other approaches are now increasingly being considered as      treatments for the condition.

     TREATMENT OPTIONS

     Abnormal electrical activity generated by areas of heart tissue, resulting in rapid and uncontrolled      contractions, usually triggers A-Fib. Treatment is commonly focused on using drugs to block the      conduction of these abnormal signals, although their effectiveness is limited.

     A-Fib can be treated through other techniques, including the Maze procedure. Incisions are made into the      heart muscle in this open-heart surgery, which blocks the conduction of the abnormal electrical impulses.      Although relatively successful, this is a highly invasive procedure and is not now widely used.

     This approach has, however, led to pioneering electrophysiologists finding a way to similarly interrupt      these signals. A minimally invasive endocardial catheter can deliver high energy to the inside of the atrial      wall, mimicking the surgical incisions. Catheter ablation for the treatment of A-Fib has advanced      significantly from the first experimental techniques.

     A number of catheter ablation methodologies have evolved, generally aiming to isolate the pulmonary      veins. Two methods for this exist – through either anatomically guided isolation of each pulmonary vein or      electrical disconnection of the pulmonary veins guided by a circular mapping catheter.

     In addition to pulmonary vein disconnection, other techniques such as Complex Fractionated Atrial      Electrograms (CFAEs) have been tested, Additional sources of abnormal electrical activity in the atria,      including electrical rotors and ganglionated plexuses, can be localised and then ablated. Current ablation      strategies have resulted in higher success rates, often up to 80%.

     THE ROLE OF TECHNOLOGY

     An area of increasing sophistication in this field is the ability to accurately map the areas of heart tissue      targeted for ablation. It is now common to create a three-dimensional computerised map of the atria, and      to record the progress of the ablation using computer-generated markers.

     In the search for even greater accuracy in the placement of ablation lesions, new technologies can      combine a CT or MRI image with electroanatomical computerised mapping, or intracardiac echography.     Three-dimensional reconstructions of actual left atrial-pulmonary vein relationships and highlighted      variations in anatomy can then be created. Such technologies have the potential to reduce the learning      curve of the procedure and present new prospects for standardisation of the technique.

     Together, these methodological and technological advances have significantly improved both the overall      success and safety of the procedure since the first experimental and investigational approaches.

     A recent review of data from over 23,000 patients justly concluded that although it is still continually      changing, catheter ablation can now be considered a mainstream approach to the treatment of A-Fib.