Prof. Sabine Ernst,
View the Slides from this session in ESC Congress 365
It is now increasingly clear that atrial fibrillation (AF) is an inherited disease as demonstrated by M Olesen (Copenhagen, DK) in the first presentation of the session. Genome wide association studies are used to detect genetic loci associated with AF. However, the precise pathophysiologic consequences of the AF susceptibility loci is still not completely understood and further investigations in larger cohorts are warranted.
Morten O’Neill (London, GB) reported on the clinical studies focussing on the substrate of AF which all demonstrated a clear association between AF and atrial fibrosis. Late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging as well as electroanatomical voltage mapping techniques are employed to visualize and quantify atrial fibrosis. Reproducibility and prospective analysis of the imaging results as a personalized roadmap for the individual patient is still limited, mostly due to the lack of spatial resolution during image acquisition.
Novel muliti-electrode mapping systems have recently entered the arena of EP mapping of AF, which allow simultaneous recordings even outside the catheter lab. Sebastian Knecht’s (Brussels, BE) presentation focused on the use of the body surface mapping system ecVUE (Cardiolnsight) in a multicentre trial of AF mapping and ablation. Using this “global” electrical information, concurrent electrical activation can be identified that presents like drivers or foci of AF. Ablation strategies aiming at these novel targets arer investigated at present, but multicentre outcome data is only preliminary as of now.
Petr Neuzil (Praha, CZ) presented on the multitude of novel ablation catheters that all aim at improving lesion quality and durability. Alternative energy sources such as laser, cryo and ultrasound energy have been investigated in recent years. Great caution needs to be applied however to avoid “overshooting” with lesion formation and thereby risking collateral damage (which could in the worst case be life-threatening). Combinations of geometry acquisition and lesion deployment in a single device (eg. By ultrasound) are currently investigated.
In summary, the understanding of the individual substrate for atrial fibrillation is still very limited and adequate “tailoring” of the applied ablation strategy is not widely applicable at present. Further technologic improvements in imaging, mapping and catheters are necessary to improve the outcome of this treatment option for AF patients.
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