An Anatomic Approach to Prevention of Atrial Fibrillation: Pulmonary Vein Isolation with Through-the-Balloon Ultrasound Ablation (TTB-USA)

Abstract Our current understanding is that atrial fibrillation (AF) is initiated most often by a focal trigger from the orifice of or within one of the pulmonary veins. Though mapping and ablation of these triggers appears to be curative in most patients with paroxysmal AF, there are a number of limitations to ablating focal triggers via mapping and ablating the earliest site of activation with a “point” radiofrequency lesion. One way to circumvent thesen limitations is an anatomically-guided ablative approach. By electrically isolating one or more pulmonary veins from the left atrium with a circumferential lesion, firing from within those veins would be unable to reach the body of the atrium, and thus could not trigger atrial fibrillation. We have developed a novel overthe-wire catheter design which integrates a cylindrical ultrasound transducer within a saline filled balloon, termed TTB-USA (through-the-balloon ultrasound ablation) in order to produce narrow circumferential zones of hyperthermic tissue death at the pulmonary vein ostia. Animal studies show great promise, and clinical trials will begin soon.