Moving-Shot versus Fixed Electrode Techniques for Radiofrequency Ablation: Comparison in an Ex-Vivo Bovine Liver Tissue Model

하은주,백정환,이정현 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.6

Objective: To compare the ablation characteristics of the moving-shot technique (MST) and the fixed electrode technique (FET) for radiofrequency (RF) ablation in an ex-vivo bovine liver tissue model. Materials and Methods: We performed RF ablation using FET in 110 bovine liver blocks using 11 different ablation times ranging from 5 seconds to 5 minutes (10 blocks per each time duration). Ten bovine liver blocks at each ablation time of 1- or 2-minute, were ablated with MST, which treated conceptual ablation units by moving the electrode tip. We evaluated the ablation volume obtained with FET across ablation time lengths. The results of FET and MST performed with the same ablation time lengths, i.e., 1- and 2-minute ablation time were also compared. Results: The ablation volume achieved with FET gradually increased with increasing ablation time; however, the pair-wise statistical comparison between 2 neighboring ablation time lengths was not significant after 30 seconds. MST with either 1- or 2-minute ablation time achieved larger ablation volumes (1.1 ± 0.2 mL vs. 2.7 ± 0.3 mL, p < 0.001; and 1.4 ± 0.2 mL vs. 5.6 ± 0.4 mL, p < 0.001, respectively), longer true RF times (46.7 ± 4.6 seconds vs. 60 seconds, p < 0.001; and 64.8 ± 4.6 seconds vs. 120 seconds, p < 0.001, respectively), fewer numbers of RF cut-offs (1.6 ± 0.5 vs. 0, p < 0.001; and 5.5 ± 0.5 vs. 0, p < 0.001, respectively), and greater energy deposition (2050.16 ± 209.2 J vs. 2677.76 ± 83.68 J, p < 0.001; and 2970.64 ± 376.56 J vs. 5564.72 ± 5439.2 J, p < 0.001, respectively), than FET. Conclusion: The MST can achieve a larger ablation volume by preventing RF cut-off, compared with the FET in an ex-vivo bovine liver model.

Does Artificial Ascites Induce the Heat-Sink Phenomenon during Percutaneous Radiofrequency Ablation of the Hepatic Subcapsular Area?: an in vivo Experimental Study Using a Rabbit Model

김영선,임현철,임효근,최동일 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.1

Objective: To evaluate the effect of the heat-sink phenomenon induced by artificial ascites on the size of the ablation zone during percutaneous radiofrequency (RF) ablation of the hepatic subcapsular area in an in vivo rabbit model. Materials and Methods: A total of 21 percutaneous rabbit liver RF ablations were performed with and without artificial ascites (5% dextrose aqueous solution). The rabbits were divided into three groups: a) control group (C, n = 7); b) room temperature ascites group (R, n = 7); and c) warmed ascites group (W, n = 7). The tip of a 1 cm, internally cooled electrode was placed on the subcapsular region of the hepatic dome via ultrasound guidance, and ablation was continued for 6 min. Changes in temperature of the ascites were monitored during the ablation. The size of the ablation zones of the excised livers and immediate complications rates were compared statistically between the groups (Mann-Whitney U test, Kruskal-Wallis test, linear-by-linear association, p = 0.05). Results: One rabbit from the “W” group expired during the procedure. In all groups, the ascites temperatures approached their respective body temperatures as the ablations continued; however, a significant difference in ascites temperature was found between groups “W” and “R” throughout the procedures (39.2± 0.4℃in group W and 33.4±4.3℃ in group R at 6 min, p = 0.003). No significant difference was found between the size of the ablation zones (782.4±237.3 mL in group C, 1,172.0±468.9 mL in group R, and 1,030.6±665.1 mL in group W, p = 0.170) for the excised liver specimens. Diaphragmatic injury was identified in three of seven cases (42.9%) upon visual inspection of group “C” rabbits (p = 0.030). Conclusion: Artificial ascites are not likely to cause a significant heat-sink phenomenon in the percutaneous RF ablation of the hepatic subcapsular region. Objective: To evaluate the effect of the heat-sink phenomenon induced by artificial ascites on the size of the ablation zone during percutaneous radiofrequency (RF) ablation of the hepatic subcapsular area in an in vivo rabbit model. Materials and Methods: A total of 21 percutaneous rabbit liver RF ablations were performed with and without artificial ascites (5% dextrose aqueous solution). The rabbits were divided into three groups: a) control group (C, n = 7); b) room temperature ascites group (R, n = 7); and c) warmed ascites group (W, n = 7). The tip of a 1 cm, internally cooled electrode was placed on the subcapsular region of the hepatic dome via ultrasound guidance, and ablation was continued for 6 min. Changes in temperature of the ascites were monitored during the ablation. The size of the ablation zones of the excised livers and immediate complications rates were compared statistically between the groups (Mann-Whitney U test, Kruskal-Wallis test, linear-by-linear association, p = 0.05). Results: One rabbit from the “W” group expired during the procedure. In all groups, the ascites temperatures approached their respective body temperatures as the ablations continued; however, a significant difference in ascites temperature was found between groups “W” and “R” throughout the procedures (39.2± 0.4℃in group W and 33.4±4.3℃ in group R at 6 min, p = 0.003). No significant difference was found between the size of the ablation zones (782.4±237.3 mL in group C, 1,172.0±468.9 mL in group R, and 1,030.6±665.1 mL in group W, p = 0.170) for the excised liver specimens. Diaphragmatic injury was identified in three of seven cases (42.9%) upon visual inspection of group “C” rabbits (p = 0.030). Conclusion: Artificial ascites are not likely to cause a significant heat-sink phenomenon in the percutaneous RF ablation of the hepatic subcapsular region.

Direction of Tissue Contraction after Microwave Ablation: A Comparative Experimental Study in Ex Vivo Bovine Liver

Lee Junhyok,Rhim Hyunchul,Lee Min Woo,Kang Tae Wook,Song Kyoung Doo,Lee Jeong Kyong 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.1

Objective: This study aimed to investigate the direction of tissue contraction after microwave ablation in ex vivo bovine liver models. Materials and Methods: Ablation procedures were conducted in a total of 90 sites in ex vivo bovine liver models, including the surface (n = 60) and parenchyma (n = 30), to examine the direction of contraction of the tissue in the peripheral and central regions from the microwave antenna. Three commercially available 2.45-GHz microwave systems (Emprint, Neuwave, and Surblate) were used. For surface ablation, the lengths of two overlapped square markers were measured after 2.5- and 5-minutes ablations (n = 10 ablations for each system for each ablation time). For parenchyma ablation, seven predetermined distances between the markers were measured on the cutting plane after 5- and 10-minutes ablations (n = 5 ablations for each system for each ablation time). The contraction in the radial and longitudinal directions and the sphericity index (SI) of the ablation zones were compared between the three systems using analysis of variance. Results: In the surface ablation experiment, the mean longitudinal contraction ratio and SI from a 5-minutes ablation using the Emprint, Neuwave, and Surblate systems were 28.92% and 1.04, 20.10% and 0.53, and 24.90% and 0.45, respectively (p < 0.001). A positive correlation between longitudinal contraction and SI was noted, and a similar radial contraction was observed. In the parenchyma ablation experiment, the mean longitudinal contraction ratio and SI from a 10-minutes ablation using the three pieces of equipment were 38.60% and 1.06, 32.45% and 0.61, and 28.50% and 0.50, respectively (p < 0.001). There was a significant difference in the longitudinal contraction properties, whereas there was no significant difference in the radial contraction properties. Conclusion: The degree of longitudinal contraction showed significant differences depending on the microwave ablation equipment, which may affect the SI of the ablation zone.

Prevalence and Characteristics of Atrial Tachycardia From Noncoronary Aortic Cusp During Atrial Fibrillation Catheter Ablation

Myung-Jin Cha,Jun Kim,Yoon Jung Park,Min Soo Cho,Hyoung-Seob Park,Soonil Kwon,Young Soo Lee,Jinhee Ahn,Hyung-Oh Choi,Jong-Sung Park,YouMi Hwang,Jin Hee Choi,Ki-Won Hwang,Yoo-Ri Kim,Seongwook Han,Seil 대한심장학회 2022 Korean Circulation Journal Vol.52 No.7

Background and Objectives: Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF. Methods: Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF). Results: Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation. Conclusions: Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.

냉각 풍선 절제술과 3D 고주파 절제술을 이용한 심방세동 치료 시 절제술 시행 시간과 방사선 피폭 영향과의 연관성

서영현 한국방사선학회 2022 한국방사선학회 논문지 Vol.16 No.4

Atrial fibrillation treatment includes 3D RFCA and Cryo-balloon ablation. Both procedures have in common that they enter after understanding the structure of the heart using angiography equipment. Therefore, there is a disadvantage that the effect of exposure according to the procedure time can be a threat to both the patient and the operator, so this study aims to confirm the relationship between the total ablation time and the effect of radiation exposure. We used follow-up data (retrospective) from 41 patients who underwent coronary angiography and arrhythmia at the same time from March 2019 to July 2022. The range for total ablation time was based on the recorded data from the start to the end of the total ablation. The end point of 3D RFCA was when the ablation was completed for 4 pulmonary veins, and in the case of Cryo-balloon ablation, the data that succeeded in electrical insulation were included. As a result of analyzing the total ablation time, the time taken for Cryo-balloon ablation was 1037.29±103.66 s, which was 2448.61 s faster than 3D RFCA using 3485.9±405.71 s, and was statistically significant. (p<0.05) As a result of analyzing the total fluoroscopy time, the exposure time for 3D RFCA was 2573.75±239.08 s, which was less by 1717.15 s than the exposure time for Cryo-balloon ablation, 4290.9±420.42 s, and was statistically significant. In the case of total area dose product, 3D RFCA was 59.04±13.1 uGy/m2, which was lower than Cryo-balloon ablation 980.6±658.07 uGy/m2 by 921.56 uGy/m2, which was statistically significant. As the insulation time of the Cryo-balloon ablation is shorter than that of the 3D RFCA, the method using the Cryo-balloon ablation is considered to be effective when the patient's condition is not good and a quick procedure is required. However, in patients with permanent Atrial fibrillation, there is a high probability of structural changes in the heart, so it is considered that 3D RFCA is better than Cryo-balloon ablation, which is difficult to manipulate. 심방세동 치료는 3D장비를 이용한 고주파 절제술과 냉각 풍선을 이용한 냉각 풍선 절제술이 있다. 두 시술 모두 혈관 조영 장비를 이용해 심장의 구조를 파악한 뒤 진입하는 공통점이 있다. 따라서 시술 시간에 따른 피폭의 영향이 환자와 시술자 모두 위협이 될 수 있다는 단점이 존재하므로 본 연구를 통해 총 절제술 시간과 방사선 피폭 영향 등의 연관성을 확인하고자 한다. 2019년 03월부터 2022년 07월까지 관상 동맥 조영술과 부정맥 시술을 동시에 시행한 41명 환자의 후행적 데이터를 이용하였다. 총 절제술 시간에 대한 범위는 절제술 시작 시점부터 종료 시점까지의 기록된 데이터를 대상으로 하였다. 3D 고주파 절제술 종료 시점은 4곳의 폐정맥에 대해 절제술 시행을 완료한 시점으로 하였고 냉각 풍선 절제술의 경우 전기적 절연에 성공한 데이터를 대상으로 하였다. 총 절제술에 걸린 시간을 분석한 결과 냉각 풍선 절제술에 걸린 시간이 1037.29±103.66 s로 3D를 이용한 고주파 절제술 3485.9±405.71 s 보다 2448.61 s 더 빠른 시술 시간을 보였고 통계적으로 유의했다. (p<0.05) 총 투시 조영 시간을 분석한 결과 3D를 이용한 고주파 절제술 피폭 시간이 2573.75±239.08 s로 냉각 풍선 절제술 피폭 시간 4290.9±420.42 s 보다 1717.15 s만큼 덜 노출됐으며 통계적으로 유의했다. 총면적 선량의 경우 3D 고주파 절제술이 59.04±13.1 uGy/m2로 냉각 풍선 절제술 980.6±658.07 uGy/m2보다 921.56 uGy/m2만큼 저 선량을 나타냈으며 통계적으로 유의했다. 냉각 풍선 절제술의 절연 시간이 3D 고주파 절제술보다 짧은 것으로 보아 환자의 상태가 좋지 않아 빠른 시술이 필요한 경우 냉각 풍선 절제술을 이용하는 방법이 효과적일 것으로 판단된다. 그러나 심방세동이 오래된 환자일 경우 심장의 구조적 변화가 발생할 확률이 높으므로 조작이 어려운 냉각 풍선 절제술 보다 3D 고주파 절제술을 이용해 치료하는 방법이 좋을 것으로 사료된다.

Value of contrast-enhanced ultrasonography in microwave ablation treatment of symptomatic focal uterine adenomyosis

Xiao-Long Li,Jia-Xin Li,Song-Yuan Yu,Pei-Li Fan,Yun-Jie Jin,Er-Jiao Xu,Sai-Nan Guan,Er-Ya Deng,Qiu-Yan Li,Zheng-Biao Ji,Jiu-Ling Qi,Hui-Xiong Xu,China Alliance of Multi-Center Clinical Study for Ultra 대한초음파의학회 2024 ULTRASONOGRAPHY Vol.43 No.1

Purpose: This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine adenomyosis.Methods: This retrospective study was conducted between March 2020 and January 2023, enrolling 52 patients with symptomatic focal uterine adenomyosis who had undergone MWA. All patients were examined with CEUS before and after MWA. The non-perfused volume (NPV) was compared between CEUS and dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) following ablation. Therapeutic efficacy and safety were evaluated at 3-, 6-, and 12-month follow-ups. Additionally, this study explored the correlations between pre-treatment CEUS features and a volume reduction ratio indicating sufficient ablation, defined as 50% or more at the 3-month follow-up.Results: No significant differences in NPV were noted between CEUS and DCE-MRI immediately after MWA and during follow-up (all P>0.05). At the 3-month follow-up, the median VRRs for the uterus and adenomyosis were 33.2% and 63.9%, respectively. Sufficient ablation was achieved in 69.2% (36/52) of adenomyosis cases, while partial ablation was observed in the remaining 30.8% (16/52). The identification of non-enhancing areas on pre-treatment CEUS was associated with sufficient ablation (P=0.016). At the 12-month follow-up, significant decreases were observed in both the uterine and adenomyosis volumes (all P<0.001). Dysmenorrhea and menorrhagia were significantly alleviated at 12 months, and no major complications were encountered.Conclusion: CEUS can be used to evaluate the ablation zone of focal adenomyosis that has been treated with MWA, similarly to DCE-MRI. The identification of non-enhancing areas on pretreatment CEUS indicates satisfactory treatment outcomes. Purpose: This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine adenomyosis. Methods: This retrospective study was conducted between March 2020 and January 2023, enrolling 52 patients with symptomatic focal uterine adenomyosis who had undergone MWA. All patients were examined with CEUS before and after MWA. The non-perfused volume (NPV) was compared between CEUS and dynamic contrast-enhanced magnetic resonance imaging (DCE- MRI) following ablation. Therapeutic efficacy and safety were evaluated at 3-, 6-, and 12-month follow-ups. Additionally, this study explored the correlations between pre-treatment CEUS features and a volume reduction ratio indicating sufficient ablation, defined as 50% or more at the 3-month follow-up. Results: No significant differences in NPV were noted between CEUS and DCE-MRI immediately after MWA and during follow-up (all P>0.05). At the 3-month follow-up, the median VRRs for the uterus and adenomyosis were 33.2% and 63.9%, respectively. Sufficient ablation was achieved in 69.2% (36/52) of adenomyosis cases, while partial ablation was observed in the remaining 30.8% (16/52). The identification of non-enhancing areas on pre-treatment CEUS was associated with sufficient ablation (P=0.016). At the 12-month follow-up, significant decreases were observed in both the uterine and adenomyosis volumes (all P<0.001). Dysmenorrhea and menorrhagia were significantly alleviated at 12 months, and no major complications were encountered. Conclusion: CEUS can be used to evaluate the ablation zone of focal adenomyosis that has been treated with MWA, similarly to DCE-MRI. The identification of non-enhancing areas on pre- treatment CEUS indicates satisfactory treatment outcomes.

완전 전도로 절제 결과 평가를 위해 동율동시 투여한 Adenosine

노지훈,이지현,임대관,박찬복,김성만,차태준,주승재,이재우 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of supraventricular tachycardia. Radiofrequency cather ablation (RFCA) of the slow pathway can treat AVNRT. Slow pathway ablation is associated with a risk of complete AV block in rare cases. In difficult cases, electrophysiologist should check degrees of artrioventriculr node(AVN) damage during and after ablation. There are several methods of identifying high risk of slow pathway ablation and identifying degree of AVN damage, but sometimes there are not perfect. Adenosine is effective in AVNRT termination by influencing AVN conduction. Use of adenosine can identify change of AVN conduction properties Methods : Adenosine tests were studied in 24 patients (10 men, 14 woman:43.5± 16.6 years) with inducible sustained AVNRT. Adenosine 6㎎ and 12㎎ were injected before and after successful ablation of slow pathway during sinus rhythm. Results : With adenosine 6㎎ injection, AVNRT occurred in 13patients and A-H jump in 15 patients before ablation, whereas AVNRT occurred in no patient and A-H jump in 5 atients after ablation. Adenosine 6㎎ induced AV block beats were significantly increased from 0.4±1.5 to 4.0±4.0 beats by ablation (p<0.05). Adenosine 6㎎ induced longest RR interval was also significantly increased from 876±319 to 1575±852 msec by ablation (p<0.05). And then adenosine 12 ㎎ were injected before and after ablation of slow pathway in 21 patients. AVNTR occurred in 13 versus 0 patient, A-H jump occurred in 16 versus 9 patients. the longest RR interval was 1590±714 versus 4245±3492 msec(p<0.05). Conclusion : After successful RFCA of AVNRT, adenosine increases the number of AV block beats and the longest RR interval significantly. Administration of adenosine during and after ablation can identify severe AV nodal damage which was induced by ablation. Administration of adenosine during and after RFCA enables us to estimate amount of AV nodal damage and it give us information about when to stop the cather ablation. Adenosine can be useful to identify patients with impending heart block during and after ablation of slow pathway.

완속 전도로 절제 결과 평가를 위해 동율동시 투여한 Adenosine

노지훈,이지현,임대관,박찬복,김성만,차태준,주승재,이재우 고신대학교(의대) 고신대학교 의과대학 학술지 2004 고신대학교 의과대학 학술지 Vol.19 No.1

Background : Atrioventricular nodal recentrant tachycardia (AVNRT) is the most common form of supraventriicular tachycardia. Radiofrequency catheter ablation (RFCA) of the slow pathway can treat AVNRT. Slow pathway ablation is associated with a risk of complete AV block in rare cases. In difficult cases, electrophysiologist should check degrees of atrioventricular node (AVN) damage during and after ablation. There are several methods of identifying high risk of slow pathway ablation and identifying degree of AVN damage, but sometimes there are not perfect. Adenosine is effective in AVNRT termination by influencing AVN conduction. Use of adenosine can identify change of AVN conduction properties. Methods : Adenosine tests were studied in 24 patients (10 men, 14 women: 43.5±16.6 years) with inducible sustained AVNRT. Adenosine 6mg and 12mg were injected before and after successful ablation of slow pathway during sinus rhythm. Results : With adenosine 6mg injection, AVNRT occurred in 13 patients and A-H jump in 15 patients before ablation, whereas AVNRT occurred in no patient and A-H jump in 5 patients after ablation. Adenosine 6mg induced AV block beats were significantly increased from 0.4±1.5 to 4.0±4.0 beats by ablation (p<0.05). And then adenosine 12mg were injected before and after ablation of slow pathway in 21 patients. AVNRT occurred in 13 versus 0 patient, A-H jump occurred in 16 versus 9 patients. The longest RR interval was 1590±714 versus 4245±3492 msec (p<0.05). Conclusion : After successful RFCA of AVNRT, adenosine increases the number of AV block beats and the longest RR interval significantly. Administration of adenosine during and after ablation can identify severe AV nodal damage which was induced by ablation. Administration of adenosine during and after RFCA enables us to estimate amount of AV nodal damage and it give us information about when to stop the catheter ablation. Adenosine can be useful to identify patients with impending heart block during and after ablation of slow pathway.

Ablative Outcomes of Various Energy Modes for No-Touch and Peripheral Tumor-Puncturing Radiofrequency Ablation: An Ex Vivo Simulation Study

Cha Dong Ik,Lee Min Woo,Song Kyoung Doo,Ko Seong Eun,Rhim Hyunchul 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.2

Objective: To compare the outcomes of radiofrequency ablation (RFA) using dual switching monopolar (DSM), switching bipolar (SB), and combined DSM + SB modes at two different interelectrode distances (25 and 20 mm) in an ex vivo study, which simulated ablation of a 2.5-cm virtual hepatic tumor. Materials and Methods: A total of 132 ablation zones were created (22 ablation zones for each protocol) using three separable clustered electrodes. The performances of the DSM, SB, and combined DSM + SB ablation modes were compared by evaluating the following parameters of the RFA zones at two interelectrode distances: shape (circularity), size (diameter and volume), peritumoral ablative margins, and percentages of the white zone at the midpoint of the two electrodes (ablative margin at midpoint, AMm) and in the electrode path (ablative margin at electrode path, AMe). Results: At both distances, circularity was the highest in the SB mode, followed by the DSM + SB mode, and was the lowest in the DSM mode. The circularity of the ablation zone showed a significant difference among the three energy groups (p < 0.001 and p = 0.002 for 25-mm and 20-mm, respectively). All size measurements, AMm, and AMe were the greatest in the DSM mode, followed by the DSM + SB mode, and the lowest were with the SB mode (all statistically significant). The white zone proportion in AMm and AMe were the greatest in the SB mode, followed by the DSM + SB mode and DSM in general. Conclusion: DSM and SB appear to be complementary in creating an ideal ablation zone. RFA with the SB mode can efficiently eradicate tumors and create a circular ablation zone, while DSM is required to create a sufficient ablative margin and a large ablation zone.

2018 심방세동 카테테 절제술 대한민국 진료지침: Part III

이정명,정동섭,유희태,박희남,박형섭,심재민,김주연,김준,윤남식,오세일,노승영,조영진,김기훈 대한부정맥학회 2018 International Journal of Arrhythmia Vol.19 No.3

Catheter ablation of atrial fibrillation (AF) is one of the most complex interventional electrophysiological procedures. The success of AF ablation is based in large part on freedom from AF recurrence based on electrocardiography (ECG) monitoring. Arrhythmia monitoring can be performed with the use of noncontinuous or continuous ECG monitoring tools. AF ablation is an invasive procedure that entails risks, most of which are present during the acute procedural period. However, complications can also occur in the weeks or months following ablation. Recognizing common symptoms after AF ablation and distinguishing those that require urgent evaluation and referral to an electrophysiologist is an important part of follow-up after AF ablation. This section reviews the complications associated with catheter ablation procedures performed to treat AF. The types and incidence of complications are presented, their mechanisms are explored, and the optimal approach to prevention and treatment is discussed. Finally, surgical and hybrid AF ablation technology and the indications for concomitant open or closed surgical ablation of AF, stand-alone and hybrid surgical ablation of AF are covered in this section.