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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2015; 7(11): 754-764
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.754
Visualization of catheter ablation for atrial fibrillation: Impact of devices and anatomy
Mark A Benscoter, Paul A Iaizzo
Mark A Benscoter, Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, United States
Mark A Benscoter, Department of Engineering, Mayo Clinic, Rochester, MN 55905, United States
Paul A Iaizzo, Department of Surgery, University of Minnesota, Minneapolis, MN 55455, United States
Author contributions: Benscoter MA performed literature review, generated images and wrote the paper; Iaizzo PA collected images and edited the paper.
Supported by Research contract with Medtronic, Inc. (Minneapolis, MN).
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul A Iaizzo, PhD, Department of Surgery, University of Minnesota, 420 Delaware Street SE, B172 Mayo, MMC 195, Minneapolis, MN 55455, United States. iaizz001@umn.edu
Telephone: +1-612-6247912 Fax: +1-612-6242002
Received: March 25, 2015
Peer-review started: March 26, 2015
First decision: May 13, 2015
Revised: September 24, 2015
Accepted: October 16, 2015
Article in press: October 19, 2015
Published online: November 26, 2015
Processing time: 250 Days and 5.7 Hours
Abstract

Endocardial access to the left atrium is commonly achieved to treat patients with atrial fibrillation, using different device delivery systems for cardiac ablation. But the large variation in human anatomy presses the limits of existing medical devices. In this unique study, we directly visualized the device-tissue interface in fresh reanimated human hearts using Visible Heart® methodologies. Our goal was to better understand any opportunities to improve therapeutic approaches. The visual images obtained in this study (also featured in this article) allow a more intimate grasp of the key steps required in various ablation procedures, as well as some limitations of current device designs. These images show the potential risks of conducting transseptal punctures and the difficulties of placing catheter tips in certain scenarios (e.g., when creating circumferential lesions); they also demonstrate potential problems that could occur while attempting to place catheter tips on such anatomies like the mitral isthmus. In our analysis of these images, we focus on where enhancements are needed to refine device functionality.

Keywords: Atrial fibrillation; Cryogenic catheter ablation; Radiofrequency ablation; Transseptal puncture

Core tip: Visible Heart® methodologies are utilized to directly visualize a functional human heart anatomy and key steps in the cardiac ablation procedure to emphasize limitations of current device delivery systems. Specifically, these images illustrate potential risks of transseptal punctures as well as the challenges faced by clinicians when placing catheter tips in certain scenarios, considering the wide variation in human anatomy. The focus is on where enhancements are needed to refine device functionality and improve therapeutic approaches.