Biophysics of modern ablation techniques and their limitations

Abstract

Catheter ablation is now the mainstay of therapy for most cardiac arrhythmias. The interventional electrophysiologist will need a thorough understanding of the underlying biophysics of frequently used ablation tools. Most commonly utilized in the electrophysiology laboratory, radio frequency ablation follows certain principles influenced by parameters such as convective cooling and resistive or conductive heating. The catheter tip design, either nonirrigated or irrigated, will have a profound impact on lesion formation. In the quest of permanent lesion transmurality, alternative energy sources have been developed. Cryoenergy ablation is now commonly used during atrial fibrillation ablation, while laser energy ablation is being tested in the clinical arena and demonstrating encouraging results. The present chapter will discuss the biophysics of these aforementioned technologies as well as their limitations as they apply to clinical practice.