Fehmi Keçe

General Introduction 19 1 1.4 Ablation Tools & Safety For AF ablation many tools applying different energy sources have been developed and are still being amended. Point-by-point ablation of the ipsilateral pulmonary veins with radiofrequent energy with cooled single-tip catheters in combination with three- dimensional electro-anatomical mapping systems (Carto, Ensite, Rhythmia) is still a common approach in many electrophysiology laboratories. The most frequently used single-shot device is the cryoballoon ablation system. Other single-shot devices are the laserballoon, hotballoon and the non-irrigated multi-electrode catheter (PVAC-Gold). Some ablation tools have been retracted from the market due to serious safety concerns (high-intensity-focused Ultrasound Balloon, Multi-electrode catheters (MASC, MAAC, nMARQ) (48), while new ones are still begin developed (multi- electrode radiofrequency balloons). The KardiumGlobe contains 122 gold-plated mapping electrodes and 24 ablation electrodes (49) and the Multielektrode RF irrigated ablation catheter is a 28 mm diameter spherical compliant balloon with 10 gold surface electrodes to deliver radiofrequency energy, each with 4 holes for saline irrigation (50). Another new ablation concept is that pulsed field ablation (PFA), also known as electroporation, in which subsecond electric fields create microscopic pores in cell membranes (51). All of the current devices are still being improved with new features (contact force), better cooling systems and optimization of the energy source delivery aiming at improvement of the efficacy and safety of the ablation procedure. During the last decade methods are developed e.g. oesophagus temperature monitoring, active cooling during ablation and power and energy limitations to prevent certain complications during AF ablation. In the next chapter, after the description of the outline of this thesis, different ablation devices and the incidence and prevention of complications are described.