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Catheter ablation is a procedure that uses radio-frequency energy or other sources to terminate or modify a faulty electrical pathway from sections of the heart of those who are prone to developing cardiac arrhythmias such as atrial fibrillation, atrial flutter and Wolff-Parkinson-White syndrome. If not controlled, such arrhythmias increase the risk of ventricular fibrillation and sudden cardiac arrest. The ablation procedure can be classified by energy source: radiofrequency ablation and cryoablation. Catheter ablation may be recommended for a recurrent or persistent arrhythmia resulting in symptoms or other dysfunction. Typically, catheter ablation is used only when pharmacologic treatment has been ineffective. Catheter ablation of most arrhythmias has a high success rate. Success rates for WPW syndrome have been as high as 95% For SVT, single procedure success is 91% to 96% (95% Confidence Interval) and multiple procedure success is 92% to 97% (95% Confidence Interval). For atrial flutter, single procedure success is 88% to 95% (95% Confidence Interval) and multiple procedure success is 95% to 99% (95% Confidence Interval). For automatic atrial tachycardias, the success rates are 70–90%. The potential complications include bleeding, blood clots, pericardial tamponade, and heart block, but these risks are very low, ranging from 2.6 to 3.2%. For non-paroxysmal atrial fibrillation, a 2016 systematic review compared catheter ablation to heart rhythm drugs. After 12 months, participants receiving catheter ablation were more likely to be free of atrial fibrillation, and less likely to need cardioversion. However, the evidence quality ranged from moderate to very low A 2006 study, including both paroxysmal and non-paroxysmal atrial fibrillation, found that the success rates are 28% for single procedures. Often, several procedures are needed to raise the success rate to a 70–80% range. One reason for this may be that once the heart has undergone atrial remodeling as in the case of chronic atrial fibrillation patients, largely 50 and older, it is much more difficult to correct the 'bad' electrical pathways.

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Atrial fibrillation (AF) is the most common arrhythmia observed in clinical practice. It is responsible for about one third of hospitalizations related to problems of arrhythmia. AF is an important clinical entity due to the increased risk of morbidity and mortality. The consequences of AF most frequently found are hemodynamic function impairment (loss of atrial synchronized contraction, irregular and inadequately rapid ventricular rate), atriogenic thromboembolic events and tachycardia induced atrial and ventricular cardiomyopathy. With the present increase of life expectancy, AF prevalence is expected to double in the next fifty years, in particular in western countries. In collaboration with the Division of Cardiology of CHUV, a catheter ablative protocol mainly based on pulmonary vein isolation (PVI) and complex fractionated elctrograms ablations was defined in order to develop new strategies to decrease procedural time and ablation extent. More precisely, surface EGC as intracardiac electrogram (EGM) signals were recorded from different catheters at specific locations before ablation during and after PVI. The purpose of this project is to evaluate the ability of known (AF cycle length) and new intracardiac organization indices based on recorded surface ECGs and EGM signals to monitor AF organization during stepwise ablation of persistent AF.

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Cardiac ablation is a worldwide accepted minimally invasive procedure to treat Atrial Fibrillation (AF). It consists in creating lesions with a catheter in the cardiac tissue in order to cut off specific electrical pathways. During this project, based on preclinical studies, we investigated and modeled the lesion formation process. This led first to identify and quantify the different mechanisms which take place in the heating process. The model developed gave rise to a Lesion Depth Index to quantify the lesion depth based on clinical parameters used to treat patient: Force Power and Duration. Another part of this project was the analysis of the clinical study EFFICAS 1 focused on the local outcome of the Pulmonary Veins Isolation (PVI). Combining the lesion depth model with the clinical analysis permitted to upgrade the analysis and confirmed that the model developed was relevant for clinical analysis. Moreover, this clinical study, allowed us to discover that the smallest lesion performed in a given microscopic area is a key predictor for isolation defect in PVI. Therefore, we showed that performing transmural ablation at the first shot is essential for a good PVI.

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Catheter ablation

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La fibrillation atriale, anciennement appelée fibrillation auriculaire (fréquemment abrégée en « FA ») est le plus fréquent des troubles du rythme cardiaque. Elle fait partie des troubles du rythme supra-ventriculaires. Elle correspond à une action non coordonnée des cellules myocardiques auriculaires, entraînant une contraction rapide et irrégulière des oreillettes cardiaques. Le terme de fibrillation auriculaire est d'usage fréquent, mais depuis 1998 la dénomination académique est « fibrillation atriale », les oreillettes cardiaques ayant été renommées « atria » dans la nouvelle nomenclature anatomique.