With the growing development of cryoablation and catheters like the nMARQ, do you think there will be room for the conventional radiofrequency for paroxysmal AF in the next few years or do you think its use will be reserved for persistent AF?
For me conventional method is the most universal method, that can be applied to the diversity of anatomical variants. You can also asses voltage of the atrium, that may inflence the risk of recurrence. Besides, it was proven that joint isolation of superior and inferior veins is better than individual vein isolation.
I think that the percutaneous treatment of atrial fibrilation have multiple features, including the patient, the electrophisiologist operator, the condictions of the cardiologic center, the increase of the studies and increase in the number of center performing the procedure. Personal opinion or litle sample are not adequate this moment.
Many electrophysioogists favour single-shot technologies. All have one disadvantage: you cannot react to specific situations such as atrial scar which you may have not expected, atrial tachycardias which you encounter during the procedure. Furthermore single shot technologies may not exactly fit the specific anatomy. Therefore I think there is enough space for conventional catheters with electoranatomical mapping.
Having personal experience with almost all available technologies and with on line imaging with intracardiac echocardiography, point by point ablation is for me still gold standard. It allows tailored procedure for individual anatomy and for additional ablation (such as CTI or some other foci). Based on our data, it is alo very safe (including the rate of cerebral microembolism). With experience, the length of the procedure is not subtantially different from single shot or balloon technologies.
I feel exactly the same as Dr Kautzner. In addition, I now almost exclusively perform all AF ablations with robotic assistance. We have exceeded 730 robotically assisted cases. It is unthinkable now for me to consider manual AF ablation. Current Robotic systems use conventional RF energy and are integrated with 3 D mapping. I remain concerned about radiation exposure with single shot technologies. Furthermore, the vast majority of patients with AF referred to me for ablation have persistent AF and require additional ablation over and above PV isolation.
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