20/20: Twenty years after the first catheter ablation of atrial fibrillation. Towards freedom from procedure related complications and atrial fibrillation recurrence

Abstract

We studied the impact of advances in the development of AF devices on the incidence of complications. More specifically, the safety of the improved non-irrigated catheter (PVAC-Gold) was investigated. The first generation of this catheter showed a high incidence of asymptomatic cerebral embolism. Subsequently, the ablation device and protocol were revised to improve the safety of this device. Therefore, we investigated whether these revisions improved the incidence of cerebral infarcts by comparing it in a randomized fashion with an irrigated catheter. Secondly, the cryoballoon ablation catheter, was investigated to prevent complications by optimizing the ablation duration. The development of the second-generation cryoballoon brought a significant improvement in terms of efficacy. To prevent complications however, the ablation duration still needed to be optimized. We aimed to optimize the ablation duration by randomizing patients to different ablation durations using the incidence of dormant conduction as an indicator for incomplete isolation. Furthermore we tried to predict the absence of incomplete cryoballoon applications, making the standard waiting period after ablation unnecessary. Finaly, we focused on posterior left atrial box isolation in patients with progressive left atrium illness and investigated the effect of the ablation surface area on the outcome of the ablation.