Biophysics of Radiofrequency Ablation for Cardiac Arrhythmias: A Current Review

• Published in: Current treatment options in cardiovascular medicine Vol. 26; no. 8; pp. 221 - 231
• Main Authors: Matos, Carlos D., Romero, Jorge E., Steiger, Nathaniel A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2024; Springer Nature B.V
• Subjects: Ablation; Biophysics; Cardiac arrhythmia; Cardiology; Catheters; Electrodes; Energy; Heat transfer; Medicine; Medicine & Public Health; Radio frequency; Topical Collection on Arrhythmia; Veins & arteries; Radiofrequency ablation; Ventricular tachycardia; Bipolar ablation; Biophysics; High-power short-duration ablation; Atrial fibrillation
• ISSN: 1092-8464; 1534-3189
• DOI: 10.1007/s11936-024-01043-5

Purpose of review This review discusses the role of radiofrequency (RF) catheter ablation for the treatment of cardiac arrhythmias and how recent advances in the understanding of RF biophysics have increased procedural safety and efficacy. Recent findings For the treatment of atrial arrhythmias, strategies that can achieve transmural lesions while avoiding collateral injury to neighboring structures are essential. Advancements such as contact force sensing, high-power short-duration RF application, ablation lesion indices, and esophageal protection have improved the safety and efficacy of catheter ablation in the atrium. In contrast to atrial arrhythmias, substrate in ventricular myocardium is often deep and may be surrounded by fibrosis, fat, and calcified scar, which can impair delivery of RF and prevent adequate lesion formation. Understanding RF biophysics allows the operator to optimize energy delivery to create deeper and larger lesions. Strategies such as RF delivery with careful power titration, high impedance irrigants, bipolar ablation, and needle intramyocardial ablation with the SERF system allow successful treatment of ventricular arrhythmias that are refractory to conventional approaches. Summary Advancements in the understanding of RF biophysics continue to be fundamental to the evolution of the treatment of cardiac arrhythmias.