Exploring novel techniques for ablation of cardiac arrhythmia Challenges and opportunities

This PhD thesis investigates innovative approaches to improve the efficacy and safety of catheter ablation for cardiac arrhythmia, adressing two key challenges: identification of arrhythmia mechanisms and creation of durable ablation lesions.
Part I explores advanced mapping techniques that aim to enhance the identification of arrhythmia mechanisms. High-density mapping is evaluated for its ability to delineate complex atypical atrial flutter circuits, while charge density mapping is used to identify arrhythmia mechanisms in patients with recurrent atrial tachyarrhythmias after surgical ablation. Additionally, a high-density substrate mapping strategy for ventricular tachycardia ablation in ischemic cardiomyopathy is investigated, including comparisons with conventional approaches and identification of predictors of long-term procedural success.
Part II examines novel ablation techniques designed to enhance lesion durability. Dielectric imaging is evaluated as a technique that could enhance guidance of radiofrequency ablation lesion creation through real-time wall thickness measurements and tissue characterization. Ultra-low temperature cryoablation is evaluated by analysing lesion durability during repeat ablation procedures. Lastly, pulsed field ablation outcomes are examined by comparing acute performance across two commercially available systems and by characterising the incidence and implications of early arrhythmia recurrence.
Part III synthesizes the findings, demonstrating that while certain high-density mapping approaches and novel ablation technologies offer meaningful opportunities to improve outcomes, others provide limited added value and leave critical challenges unresolved.