[Innovations in invasive electrophysiology : What awaits us?]

Technological developments in percutaneous catheter ablation for the treatment of cardiac arrhythmias have progressed from direct current shock ablation over the introduction of radiofrequency ablation to routine clinical procedures. Invasive electrophysiology is characterized by continuous technical innovation and an accompanying increasing understanding of underlying electrophysiologic mechanisms. A number of technical developments were promising, e.g., laser ablation, multipolar biphasic ablation, cryoballoon ablation, contact force, high density three-dimensional (3D) mapping, and the concept of rotors for atrial fibrillation ablation. Despite intense progress, one of the main challenges of catheter ablation is still the creation of tissue-specific chronic transmural lesions and avoidance of collateral damage. The purpose of this review is to present a status quo of catheter ablation of supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia and to discuss future technical innovations and strategies. In the presence of the intense dynamic developments, this review can not consider all new approaches but will rather highlight some of the most promising innovations. Topics of discussion include the use of nonfluoroscopic catheter navigation, the introduction of new ablation tools, the development of alternative energy sources, the integration of new imaging modalities, and the establishment of novel ablation strategies.