HRS Board Review 2025 New Courses (Reviewers Copy)-Biophysics of Catheter Ablation_Gerstenfeld

Video Transcription

Video Summary

In this lecture, Ed Gerstenfeld from the University of California, San Francisco, explores the biophysics of catheter ablation, focusing on radiofrequency (RF) ablation and its variations, cryoablation, and the emerging pulsed field ablation. RF ablation's primary method involves heating tissue with a combination of resistive and conductive heating, with temperatures above 50°C causing irreversible myocardial injury. Techniques like large-tip and irrigated catheters allow for deeper lesion formation, though they come with risks such as steam pops. Contact force in catheter pressure impacts lesion size, emphasizing the need for balanced force during procedures. Moreover, the lecture discusses the evolution towards high power, short duration strategies that offer quicker but shallower and wider lesions. Cryoablation, utilizing cold temperatures to create lesions, offers advantages of reversible effects and adherence to cardiac tissue but generally results in smaller lesions compared to RF. The newer pulsed field ablation employs high-voltage electric fields to create electroporation, effectively targeting myocardial cells while sparing essential structures like nerves and esophageal tissues. The session concludes with a brief look at non-invasive ablation techniques like stereotactic body radiation therapy, hinting at future innovations in electrophysiology.

Keywords

catheter ablation

radiofrequency ablation

cryoablation

pulsed field ablation

myocardial injury

electroporation

contact force

non-invasive ablation