Miss Tira Rattanakosit

A Medical scientist with a business mind
‍ by day: PhD Candidate in Centre of Heart Rhythm Disorder
‍♀️ by night: Director of The Sorcerer's Bar

Project: PhD CandidateAtrial fibrillation (AF) is the most common type of arrhythmia seen in clinical practice. This asymptomatic disease affects approximately 1%–2% of the population and is one of the most common underlying cause of stroke. The underlying pathological initiation of AF is still under research. The abnormal electrical signal generally comes from the Pulmonary Vein. However, other tissue areas such as the coronary sinus musculature and superior vena cava have been recently identified as one of the initiation sites. The pathophysiology of AF demonstrates a complex relationship between the triggers, substrate and autonomic influences, thus the adverse cardiac physiological alterations may limit the possibility to restore and maintain the normal sinus rhythm.

Although options like antiarrhythmic drugs are widely used to combat the disorganized beats, due to poor efficacy of pharmacological therapy, patients are often recommended to undergo catheter ablations. An energy source such as Cryoablation (cold energy) and Radiofrequency ablation (hot energy) are used to ablate the dysfunction tissue. With recent studies showing Radiofrequency ablation (RF) to have high successful rates and less fluoroscopy exposure time, compared to Cryoablation, RF ablation catheter is now predominately used. The ablation for atrial fibrillation requires extensive ablation that involves the risk of collateral damage to the oesophagus, pulmonary veins, lungs, and the circumflex coronary artery. At the same time, there is recurrence due to gaps in linear ablation lines due to the recovery or repair of the tissue by the body.

This indicates that the key factors such as force, time and power, plays a predominant role in forming durable transmural lesions. Recently, novel indices have combined these key factors in a weighted formula known as Ablation Index and Lesion-Size Index to assist in lesion delivery. Further studies on these areas will provide better knowledge of lesion creation and its durability.