Contemporary challenges in radiofrequency catheter ablation of atrial fibrillation

Abstract

The aim of this thesis was to broadly study and improve radiofrequency catheter ablation (RFCA) treatment of atrial fibrillation (AF), from diagnostic work-up to procedural outcomes and post-procedural imaging. We showed that, over the past decade, patient and procedure characteristics have significantly changed, but procedural success remained similar. Furthermore, we revealed that a minimal ablation strategy of pulmonary vein antrum isolation alone without additional substrate modification is benificial for the majority of patients after five years of follow-up. Patients that did not benefit from treatment suffered mainly from severely remodeled atria. We demonstrated that adenosine testing after pulmonary vein antrum isolation should be performed after a 30 min observation period in order to sufficiently reveal dormant conduction. Last, we discussed imaging of left atrial appendage thrombus prior to AF ablation by computed tomography angiography and analyzed incidence of pulmonary vein stenosis after RFCA.