Radiofrequency catheter ablation in atrial arrhythmias : insight into pre-procedural evaluation and procedural guidance

Radiofrequency catheter ablation (RFCA) has become an important treatment option in the management of supraventricular arrhythmias such as atrioventricular (nodal) re-entry tachycardia, atrial tachycardia, atrial flutter and atrial fibrillation (AF). Particularly in the management of AF the number of RFCA procedures performed is growing rapidly. Three-dimensional electroanatomical mapping combined with non-invasive imaging is currently a state of the art technique to guide RFCA for complex arrhythmias such as AF ablation, providing information on anatomical landmarks and arrhythmogenic substrate with higher accuracy and with less radiation exposure than fluoroscopy or conventional catheter based mapping. Importantly, accurate characterization of the arrhythmogenic substrate and the underlying mechanisms of the arrhythmia as well as visualization of anatomical landmarks are pivotal to optimize the results of RFCA. Comprehensive pre-procedural evaluation may help to identify the appropriate substrate as well as to identify patients with a high likelihood to benefit from a RFCA procedure.Bayer Healthcare Pharmaceuticals, Biosense Webster, MSD, Toshiba medical systems and ABN-AMROUBL - phd migration 201