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1.1 The burden of complex arrhythmias Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 9% of the population over 70 years of age (Feinberg, Blackshear et al. 1995). It is characterised by an irregular pulse, leading to symptoms of shortness of breath, dizziness, palpitations, chest pain, lethargy and an increased risk of stroke (Kannel, Abbott et al. 1982). Current widely accepted indications for catheter ablation of AF are significant symptoms uncontrolled by anti-arrhythmic medications, however more recent European Guidelines have suggested catheter ablation may be used as a first line treatment for symptomatic paroxysmal AF in patients with no or minimal heart disease. Randomised trials from 2003 2010 have shown a range of success rates for catheter ablation of AF from 56 89% (freedom from AF off antiarrhythmic drugs) compared to the use of AADs alone ranging from 4 43% (Camm, Kirchhof et al. ; Kannel, Abbott et al. 1982). Atrial tachycardia (AT) is relatively rare, accounting for 5-15% of all supraventricular tachycardias (SVTs). It can be encountered in patients with a structurally normal heart or those with underlying structural or scar-related heart disease. In patients with structurally normal hearts, atrial tachycardia is associated with a low mortality rate. However spontaneous resolution of symptomatic episodes is uncommon. Prolonged episodes (typically months or years) of continuous atrial tachycardia can be problematic leading to irreversible changes of the atria, including negative remodeling with atrial enlargement and myopathy causing symptomatic congestive cardiac failure. In addition, prolonged episodes can make reversion and maintenance of normal sinus rhythm more difficult. In recent years, the significance of AT in the initiation and perpetuation of atrial fibrillation has become apparent. Paradoxically AT occurs in up to 50% of patients undergoing extensive ablation for persistent AF. Sustained ventricular tachycardia (VT) is a significant cause of morbidity and sudden death especially in patients with underlying structural heart disease. Coronary heart disease is the most common cause of clinically documented VT occurring in 76–82% of the patients (CASCADE Study 1993; Kuch et al 2000; AVID Study 1997; CIDS Study 2000). Although implantable cardioverter defibrillators (ICD) prevent sudden cardiac death and antiarrhythmic drugs reduce the frequency of VT episodes, drug side-effects and repeated device therapies can have a major impact on quality of life (Moss et al 2004, Poole et al 2008, Schron et al 2002). Recurrent VT develops in 40-60% of patients receiving an ICD for ischaemic cardiomyopathy

Novel Technologies for Mapping and Ablation of Complex Arrhythmias