Background
1.- Topic review
Atrial fibrillation
Atrial fibrillation (AF) is the most frequent type of arrhythmia (1),
with a prevalence of 0.4-1% that increases with age,
reaching 8% in patients older tan 80 years old (2).
It increases the risk of death,
heart failure and stroke,
of which one in six ,
occurs in a patient with AF.(3)
Fig. 2
AF is treated with antiarrhythmic drugs and electric cardioversion.
When these treatments are unsuccesful,
AF lasts for more than 2 years,
or there is a left atrium enlargement of 55-60 mm,
ablation is indicated as the treatment of choice.
(4)
B.- Ablation
Several methods of ablation exist as a treatment for atrial fibrillation:
1.- Radiofrequency ablation,
point by point,
throughout the perimeter of the pulmonary veins.
During the procedure two catheters are placed: one in the atrium trough transeptal puncture,
and the other one in the coronary sinus Fig. 3 y Fig. 4
To perform the ablation the cardiologist uses a map of the atrium trough witch he can navigate freely (5).
Fig. 5
2.- Crioablation with a N2O balloon,
not precising non-fluoroscopic navigation methods Fig. 6
3.- High intensity focal ultrasounds.
In patients with poor anticoagulation control,
it can be recommended to carry out a percutaneous atrial occlusion,
which is performed at the same time as the ablation.
Fig. 7
It is demonstrated that RF ablation,
and crioablation are effective treatment techniques for AF.
Current technique was introduced in 2006,
and it is expected to continue expanding; however,
30 to 50% of patients with AF don’t achieve reversion to sinus rhythm after the first procedure (6,
7).