Letter from the Editor in Chief

DOI: 10.19102/icrm.2015.060201

MOUSSA MANSOUR, MD, FHRS, FACC

Editor-in-Chief

Dear Reader,

Recurrence of atrial fibrillation after ablation continues to be a problem that limits the widespread adoption of this procedure. Reconnection of the pulmonary veins remains the main reason for arrhythmia recurrence. A repeat procedure does not only subject the patient to unnecessary risk, but is also associated with a significant economical burden. The incremental cost of a failed ablation is not limited to the cost of the repeat procedure itself but also includes the spending associated with hospital admissions, emergency room visits, cardioversions and other expenses. As a result reducing the rate of repeat procedure is critically important, has significant economical implications, and should be the top priority of both the physicians performing the procedure and medical device companies manufacturing the tools.

Over the past few years many catheter ablation technologies have been developed and introduced in the clinical field with the aim of improving the success rate of ablation procedures. Among them is the novel technology of micro-electrodes embedded in the ablation electrode at the tip of the catheter. This new technology consists of three small electrodes measuring 0.8 mm, which are inserted in the ablation electrode, allowing the recording of bipolar signals between them. This tool is promising because it allows the detection of small electrical signals that can be missed with the conventional 3.5-10mm conventional ablation electrodes. The design also allows the delivery of radiofrequency lesions via the larger electrodes surrounding the mini-electrodes, and thus maintaining the same quality of ablation that can be obtained using conventional electrodes. While the full potential of this technology has not been fully defined, preliminary results from small studies are very encouraging. In this issue of the Journal Caldwell et al. describes the ability of this technology to precisely localize gaps along the line of ablation at the cavo-tricuspid isthmus. Our group has previously presented a study at the Scientific Session of the Heart Rhythm Society demonstrating the superiority of this technology compared to conventional mapping in detecting areas of late potentials in ventricular scar in a an animal model of healed myocardial infarction. Other potential applications include the detection of gaps along ablation lines during pulmonary vein isolation, which needs to be demonstrated in a large clinical study.

The introduction of new technologies is associated with additional cost in most situations. With the challenges resulting from the massive changes in the health care field and the cuts in reimbursement, the justification of additional expense is increasingly difficult. Robust clinical studies demonstrating unequivocal advantage of new technologies will become a necessity before the widespread acceptance of any new technology.

Best regards and I hope you enjoy reading this issue of the Journal.

Editor-in-Chief

Moussa Mansour, MD, FHRS, FACC
Editor-in-Chief
The Journal of Innovations in Cardiac Rhythm Management
MMansour@InnovationsInCRM.com
Director Cardiac Electrophysiology Laboratory,
Director Atrial Fibrillation Program
Massachusetts General Hospital
Boston, MA