Acoustic energy and cardiac electrophysiology: Ultrasonic cardiac pacing and novel shockwave ablation catheters

Sonic shockwaves (SSW) can cause cardiac pacing. This observation first came to notice with the early urologic lithotripters and later with the cumulative use of shockwaves to treat calcified coronary lesions. There have been multiple observations of cardiac pacing and tachyarrhythmias occurring during SSW delivery using the Shockwave Intravascular Lithotripsy system. The underlying mechanism of cardiac cell depolarization by SSW is still under debate. At the end of the last decade, we are witnessing this technology in electrophysiology with the WiSE‐CRT system that uses sonic waves to synchronize the ventricles and novel shockwave ablation catheters that can treat tachyarrhythmia foci with minor collateral damage.