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We report the case of a 51-year-old patient who developed a complete atrioventricular (AV) block during the isthmic radiofrequency catheter ablation of a typical atrial flutter. The cause was an acute occlusion of the segment three of the right coronary artery. His recanalization was associated with the immediate restoration of a normal AV conduction. The complication is exceptional (one of 740 consecutive atrial flutter ablations). (PACE 2010; 516-519).

In industrialized countries, the number of atrial fibrillation (AF) catheter ablation procedures regularly increases every year, but these interventions are still time consuming and complex, especially for chronic AF. The stakes in the future are twofold : to reduce the duration of each ablation procedure and to increase the success rate for the more difficult AF ablation cases (i.e. : chronic AF), but with the lowest possible complications rate. Some technological improvements may contribute to reach these goals. Intracardiac 3D mapping and navigation systems as well as robotic-assisted catheter manipulation are available and these technologies are regularly upgraded. These systems are helpful both in catheter manoeuvring and repositioning as well as in the understanding of arrhythmia circuits and the definition ablation targets. In addition, these systems are equipped with software specially designed for automatic electrogram analysis to identify myocardial areas which may play a role in the maintenance of chronic AF. Cardiac imaging, such as MRI, may also help identifying arrhythmogenic areas in patients with chronic AF, with subsequent MRI 3D images integrated into a 3D mapping / navigation system. Several companies have invested on the research and development of ablation catheters aiming both at the reduction of procedure time as well as the improvement of the quality of the created lesions, especially with 'smart'catheters which can appreciate wall contact quality. Whatever the type of catheter shape or type of energy used, technological improvement is needed before the expected efficacy is reached., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)