PREVENT HEART DISEASE The last 10 years have seen an amazing evolution in catheter ablation of atrial fibrillation.
Atrial fibrillation (AF) has gone from being an experimental technique to the most common ablation procedure performed worldwide.
Currently, there is wide consensus that the best strategy in paroxysmal AF is pulmonary vein iso - lation (PVI) while for persistent and long-standing persistent AF, a more aggressive approach including left atrium linear lesions and/ or CFAEs ablation is necessary. Hand in hand with the growth of AF ablation, the industry has progressively provided new ablation tools and imaging techniques with the aim of facilitating AF ablation, improving success and reducing complications.
The main imaging techniques that have been used over time, first included fluoroscopy, followed by intracardiac echocardiography (ICE) and virtual 3D electro-anatomic mapping, with or without magnetic resonance/computed tomography (MRI/CT) imaging integration. Considering the growing number of procedures performed, the increasing number of patients affected by AF suit- able for ablation and the consider- able costs of these new technologies, it is fundamental to know the real impact of these tools in terms of outcomes.
Fluoroscopy in AF ablation was the first imaging technique applied in clinical practice. Stud - ies of pulmonary vein isolation and fluoroscopy reported aver - ages for short-term success of 70 percent, complication rate of 4 percent, procedural time of 188 minutes, and fluoroscopy time of 61 minutes. The main advantages are the availability in every electrophysiology lab, simultaneous visualization of all catheters and real time acquisition. The disadvantages are mainly represented by 2D imaging, which may be challenging for inexperienced operators, and the long X-ray exposure required to visualize the movement of the catheters.
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