**3.4 Epicardial ablation and high-power short-duration ablations**

Two new techniques used for the catheter ablation of cardiac arrhythmias are epicardial ablation and high-power short-duration ablation. The approach in epicardial ablations is similar to that in endocardial ablations, including activation mapping, entrainment mapping, pace mapping, and substrate mapping. However, the optimal access technique and the better prevention of complications remain a subject of future research.

Electrophysiologists should be well-versed in the indications and contraindications of the epicardial approach, as well as different puncture techniques and periprocedural complications. From the posterior approach, anterior approach, needle-in-needle approach, fluoroscopic method, and wire-guided puncture technique, interventionists can select the most appropriate strategy. The surgical method should be considered in the event of pericardial adhesions. Contrastenhanced computed tomography may have additional benefits, primarily in terms of detecting abnormal anatomical, dynamic, and perfusion characteristics, but also in terms of distinguishing between epicardial fat and scar tissue.

High-power short-duration RFA is defined in a variety of ways, with power ranging from 40 to 90 W and lasting less than 15 seconds per lesion. PV isolation has been a standard strategy for the catheter ablation of AF since the pioneering work of Hassaguerre et al. in 1994 [27]. However, the long procedure times and high rates of PV reconnection that result have sparked interest in using high-power short-duration ablation. To determine the efficacy and safety profile of this novel technique, researchers looked at the particular biophysical ablation characteristics of HPSD ablation.

#### **3.5 Conclusions on radiofrequency ablation**

In conclusion, while RFA has demonstrated significant benefits in the treatment of arrhythmias, some issues remain debatable and long-term results are still needed.

### **4. Summary**

Heart rate management and control continues to be a serious problem in medicine, requiring a variety of measures, including the development of implantable cardiac devices and, in particular, the methods and medical indications for their use in the interests of an ever-widening cohort of patients in their various life and health conditions.

Such situations as pacing after syncope, pacing following transcatheter aortic valve implantation, and cardiac resynchronization therapy for both heart failure and the prevention of pacing-induced cardiomyopathy have been of ongoing interest. Automatic pacing rate control responding to the metabolic demand of the organism and pacing in various diseases of the heart, including new diagnostic tools for semiautomatic decision-making on pacing, as well as pacing the His bundle and the left bundle branch, are of intensive recent research.

New techniques are introduced for the catheter ablation of cardiac arrhythmias: epicardial ablation and high-power short-duration radiofrequency ablation. Although both the methods have demonstrated significant benefits in the treatment of arrhythmias, some issues remain debatable and long-term results are still needed. The same goes for the application of both the methods of ablation and pacing, together, although it has been used in medical practice. The combined application of both the methods of ablation and pacing has been used in medical practice, and the effectiveness of the results requires continued research. The optimal access technique and the better prevention of complications remain a subject of future research [28–32].

Finally, the experienced authors of the chapters in the present book will certainly make a significant contribution to the progress of cardiac rhythm management. Moreover, IntechOpen has made substantial contributions to the publishing of scientific and practical results in the field, and a number of books have been issued during the last decade [33–36].

*Introductory Chapter: Modern Methods and Devices for Cardiac Rhythm Management DOI: http://dx.doi.org/10.5772/intechopen.104947*
