Valeriano, Chiara (2025) Technological innovation to improve outcomes and efficiency in catheter ablation of atrial fibrillation: from advanced energy delivery to imaging integration and procedural optimization. [Tesi di dottorato]

Documento PDF PhD_Thesis_Formatted.pdf Visibile a [TBR] Utenti registrati Download (6MB) | Richiedi una copia

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and represents a major clinical and healthcare burden worldwide. Despite continuous technological advances, catheter ablation of AF still faces important challenges related to long-term efficacy, procedural safety, and workflow efficiency. This PhD thesis investigates the role of technological innovation in improving outcomes and efficiency of AF catheter ablation, integrating advances in energy delivery, procedural optimization, and imaging-based substrate characterization. The first part of the thesis evaluates high-power short-duration radiofrequency ablation and novel catheter stability algorithms, demonstrating improved lesion quality, higher procedural efficiency, and reduced procedure and fluoroscopy times without compromising safety. The second part focuses on pulsed field ablation (PFA), a non-thermal energy modality characterized by myocardial selectivity, with particular attention to its limited impact on autonomic nervous system modulation. These findings are supported by clinical data and by the design and rationale of a dedicated randomized trial (GPfIRE). In addition, the thesis addresses procedural optimization through vascular access and hemostasis management, showing that systematic ultrasound-guided venous access and the use of modern vascular closure techniques significantly reduce access-site complications and enable safe ambulatory ablation workflows. Finally, the integration of computed tomography imaging with electroanatomical and functional mapping allows a more precise characterization of the atrial substrate, highlighting the role of left atrial wall thickness and intramyocardial fat in pulmonary vein reconnection and supporting the development of personalized ablation strategies. Overall, this work demonstrates that an integrated approach combining advanced energy delivery, imaging guidance, and standardized procedural workflows can improve the effectiveness, safety, and sustainability of catheter ablation for atrial fibrillation, paving the way toward more personalized treatment strategies.

Downloads

Actions (login required)

Modifica documento