J Yeungnam Med Sci.  2024 Oct;41(4):279-287. 10.12701/jyms.2024.00703.

Invasive strategies for rhythm control of atrial fibrillation: a narrative review

• Kim HJ
• Lee CH

• KMID: 2560488
• DOI: http://doi.org/10.12701/jyms.2024.00703

Abstract

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia and its increasing prevalence has resulted in a growing healthcare burden. A recent landmark randomized trial, the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), highlighted the importance of early rhythm control in AF, which was previously underemphasized. Rhythm control therapy includes antiarrhythmic drugs, direct-current cardioversion, and catheter ablation. Currently, catheter ablation is indicated for patients with AF who are either refractory or intolerant to antiarrhythmic drugs or who exhibit decreased left ventricular systolic function. Catheter ablation can be categorized according to the energy source used, including radiofrequency ablation (RFA), cryoablation, laser ablation, and the recently emerging pulsed field ablation (PFA). Catheter ablation techniques can also be divided into the point-by-point ablation method, which ablates the pulmonary vein (PV) antrum one point at a time, and the single-shot technique, which uses a spherical catheter to ablate the PV antrum in a single application. PFA is known to be applicable to both point-by-point and single-shot techniques and is expected to be promising owing to its tissue specificity, resulting in less collateral damage than catheter ablation involving thermal energy, such as RFA and cryoablation. In this review, we aimed to outline catheter ablation for rhythm control in AF by reviewing previous studies.

Keyword

Atrial fibrillation; Catheter ablation; Cryoballoon ablation; Pulse field ablation; Radiofrequency catheter ablation

Figure

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  Fig. 1. Types of ablation catheters for atrial fibrillation. (A) Open-irrigated contact force-sensing radiofrequency ablation catheter (SMARTTOUCH catheter; Biosense Webster Inc., Diamond Bar, CA, USA). (B) Cryoballoon catheter. (C) Laser balloon catheter (HeartLight; CardioFocus, Marlborough, MA, USA). Illustrated by Yeungnam University College of Medicine research support team.

• 

  Fig. 2. Types of pulsed field ablation catheters for atrial fibrillation. (A) FARAWAVE (Boston Scientific Corp., Marlborough, MA, USA). Images provided courtesy of Boston Scientific Corp. (©2024 Boston Scientific Corp. or its affiliates. All rights reserved). (B) OMNYPULSE (Biosense Webster Inc., Diamond Bar, CA, USA) and (C) VARIPULSE (Biosense Webster Inc.). Adapted with permission from Johnson & Johnson.

Reference

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