Non-invasive diagnosis and hybrid treatment of atrial fibrillation

The emergence of novel non-invasive methods of body surface cardiac mapping allows detecting arrhythmogenic focus localization with high accuracy and contributes to superior long-term outcomes following interventional and cardiac procedures. The implementation of the original body surface cardiac mapping system “Amicard 01C” into routine clinical practice has increased drastically the reproducibility of preoperative diagnosis of life-threatening arrhythmias, timely assessment, and investigation of the complex electrophysiological pathogenesis of ventricular and atrial tachyarrhythmias.

Extensive clinical experience has proven the high accuracy of body surface cardiac mapping enabling to perform interventional procedures without additional intraoperative endocardial mapping. Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 1-2% of the general population. Catheter AF ablation is less effective for treating persistent and long-standing persistent AF. A failed catheter ablation is associated with more reduced efficacy of further ablation procedure in patients with persistent and long-standing persistent AF.

Therefore, it rationale to consider a two-stage or hybrid approach combining epi- and endocardial ablations in patients with persistent and long-standing persistent AF. The 3-year freedom from persistent and long-standing persistent AF reached 86.9% among patients who underwent staged treatment in the A.V. Vishnevsky National Medical Research Center of Surgery.

Non-invasive stereotactic radioablation of cardiac arrhythmias using linear accelerators is projected to become highly-demanded method in the near future along with non-invasive cardiac mapping modes. The first clinical cases of non-invasive radioablations have shown beneficial effects for treating life-threatening cardiac arrhythmias.

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