Atrial Fibrillation Ablation – New Approaches, New Technologies

Catheter ablation is now considered a first-line therapy for patients with symptomatic, drug-refractory atrial fibrillation (AF), but the need for great technical skills and incomplete insight into underlying mechanisms make the accomplishment of long-term favourable outcomes difficult to achieve. Technological innovation is aimed at making AF ablation a more effective practice that is no longer restricted to a few operators. The main fields of ongoing research include more reliable imaging modalities, more effective and faster ablation catheters (multielectrode and balloon catheters, catheters using alternative energy sources), force-sensing technology, remote navigation systems and algorithms implemented in the mapping systems in order to characterise the atrial substrate. Attention is also given to improving the safety profile of AF ablation procedures. Finally, novel devices for stroke prophylaxis and post-ablation follow-up have been introduced into clinical practice. Nevertheless, AF ablation remains a technically challenging procedure, and the extent to which much the new technologies and tools will be able to eventually improve outcomes and expand the current indications is still unclear.