New energy sources and technologies for atrial fibrillation catheter ablation

Ablation has become a cornerstone for the management of symptomatic atrial fibrillation (AF) in patients where anti-arrhythmic drugs fail. Electrical isolation of the pulmonary veins (PVs) is the basic step for every procedure but is still hampered by tools and energy sources that do not lead to durability of isolation. Novel therapies include high power short duration radiofrequency ablation in combination with optimal cooling of the electrode-tissue interface by irrigation or new electrode material to allow for optimal safe energy transfer. Novel tools include competitive balloon catheters using cryoenergy, laser, or radiofrequency current, or linear array ablation with ultralow temperature cryoablation to enhance durability of lesions. A novel energy source is rapidly evolving in the form of pulsed electrical field ablation resulting in irreversible electroporation of cardiac tissue, potentially without collateral side effects. Beyond PV isolation, ablation targets are still under study as standardized addition of lesion lines shows limited benefits. Mapping of the activation pattern during AF to guide patient-specific target ablation has been developing over the last decade, with mixed results by different platforms. The field of ablation for AF is evolving more rapidly than ever which will hopeful result in better long-term outcomes.