Atrial Fibrillation treatment in the last two decades: Moving from electrical cardioversion to cryoballoon ablation

Student thesis: Doctoral Thesis

Abstract

Atrial fibrillation (AF) is the most common rhythm disorder widespread in Western countries: its prevalence is estimated to be between 1% and 2% of the total population, it increases according to age to reach more than 5% after 80 years.
Catheter ablation strategies have been developed more recently with the intention of ‘curing’ AF. Indeed, these procedures are associated to significantly higher success rates if compared to antiarrhythmic drugs in maintaining sinus rhythm. The electrical disconnection of the PV from the adjacent LA, has been demonstrated to be the cornerstone of AF ablation strategy, with radiofrequency (RF) currently being the most widespread energy source. However, the RF ablation is complex, time consuming, and highly dependent on operator experience. Various techniques and different ablation strategies have been developed in an effort to simplify PVI, to allow a broader number of patients to access to this therapy.
Cryoballoon ablation displays similar efficacy and overall safety profile, when compared to radiofrequency ablation for the treatment of patients with drug-refractory paroxysmal atrial fibrillation, in any anatomical configuration, without the need to select patients according to the latter. Importantly, cryoballoon ablation seems to be less operator-dependent and more reproducible than radiofrequency for the isolation of pulmonary veins.
New improvements of ablation tools are expected in the next future, in order to improve and facilitate the procedure. But at shorter notice, we should particularly focus on the total number of cryo-applications and their adequate duration, in order to achieve and maintain a favourable clinical outcome, and to minimize the risk of complications for the vast majority of patients.
Date of Award4 Sep 2018
Original languageEnglish
Awarding Institution
  • Vrije Universiteit Brussel
SupervisorCarlo De Asmundis (Promotor), Gian Battista Chierchia (Promotor), Pedro Brugada (Co-promotor), Pascal Defaye (Jury), Andrea Sarkozy (Jury), Bernard Cosyns (Jury), Jan Poelaert (Jury), Kristin Jochmans (Jury) & Mark La Meir (Jury)

Keywords

  • Atrial Fibrillation
  • Cryoballoon Ablation

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