The role of high-intensity focused ultrasound in ablation of atrial fibrillation and other cardiac arrhythmias

Atrial fibrillation is the most prevalent arrhythmia of the heart, originating usually from ectopic atrial activity of the pulmonary veins. Therefore, one of the treatment options is pulmonary vein isolation. Among the novel approaches to pulmonary vein isolation, high-intensity focused ultrasound (HIFU) has been developed. The ultrasound energy can be focused on a specific area and would result in the formation of a lesion similar to that formed with radiofrequency (RF) ablation. Although preclinical studies were promising, clinical studies in patients resulted in lower efficacy and high complication rates in comparison to the standard ablation method, due to collateral damage. Using HIFU for epicardial approach during cardiac surgery and for extracorporeal ablation does seem to have a future role. In this review, we present the mechanism of HIFU lesion formation and the principal studies.