Innovative catheter ablation techniques for restoring sinus rhythm – customized and minimally invasive

Atrial fibrillation is the most common persistent cardiac arrhythmia. In Europe, one in three 55-year-olds will develop it during their lifetime. Atrial fibrillation manifests itself as palpitations or exertional dyspnea, and less commonly as loss of consciousness. In some patients, atrial fibrillation is diagnosed incidentally. 

The cause of atrial fibrillation lies primarily in the early stages of the disease in the pulmonary veins. This is where the triggers that initiate atrial fibrillation arise, although they are less common.

In principle, the aim should be to maintain normal sinus rhythm in all patients with atrial fibrillation.

As atrial fibrillation is associated with an increased risk of stroke, so that blood thinning is required for most of those patients. 

Catheter ablation is a minimally invasive procedure performed via the femoral vein. At the University Heart Center Freiburg - Bad Krozingen, this procedure has been carried out several times a day for over 20 years. The success rate has improved over the years, and the procedure time has been reduced to less than one hour with a very low complication rate of less than 1%.

In catheter ablation, the atrial septum is punctured with a fine needle under ultrasound guidance to access the left atrium. The pulmonary veins are then isolated in the left atrium so that the triggers present there can no longer cause arrhythmia.

If necessary, in cases of prolonged atrial fibrillation, electrically diseased tissue can also be ablated, which slightly increases the success rate. In principle, we have three different forms of energy available for this purpose. In cryoablation, the pulmonary veins are occluded with a balloon. Gas is introduced into the balloon, cooling the tissue so that it no longer conducts electricity.

In radiofrequency ablation, the tissue around the pulmonary vein opening is heated with electricity. The advantage of this procedure is that it can be adapted to individual anatomical conditions and, if necessary, other existing arrhythmias can be treated at the same time.

A newer procedure is known as pulse deficit ablation. This involves delivering high-energy pulses in the millisecond range, which are gentler on the surrounding heart structures than the procedure described above.

“All three procedures are comparable in their effectiveness. However, the different procedures offer advantages and disadvantages for individual patients. The optimal procedure is decided based on the individual circumstances”, explains Dr. Alexander Gressler, senior physician in the Department of Cardiology and Angiology at the Heart Center Freiburg Bad Krozingen.