Visualization of lesion transmurality and depth of necrosis using an ablation catheter that incorporates ultrasound imaging: a small step or a major leap forward on the road to a more durable catheter ablation procedure for treatment of atrial fibrillation?

摘要

Percutaneous catheter ablation has revolutionized the care of patients with atrial fibrillation. Pulmonary vein isolation has become the cornerstone of most ablation procedures for the treatment of atrial fibrillation following the observation by Haissaguerre et al1 that pulmonary veins were a frequent source of ectopic beats initiating atrial fibrillation. Pulmonary vein isolation may be combined with linear ablation or ablation of other targets for treatment of persistent or longstanding persistent atrial fibrillation. Pulmonary vein electrical reconnection to the left atrium is not uncommon and may be the primary reason for procedure failure among patients with paroxysmal atrial fibrillation.2"4 Pulmonary vein reconnections also have been demonstrated to be important triggers in patients with persistent atrial fibrillation undergoing repeat ablation.5 Recovery of conduction across linear ablation lesions is also likely to play a role in procedure failure among patients with persistent atrial fibrillation.6 With current technology, some tissue that is ablated recovers electrical activity. Any technology that could safely increase the probability that ablated tissue would remain ablated would be an important contribution.