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Pulmonary vein isolation to treat paroxysmal atrial fibrillation: conventional versus multi-electrode radiofrequency ablation.
MedLine Citation:
PMID:  22354772     Owner:  NLM     Status:  Publisher    
PURPOSE: For patients with symptomatic atrial fibrillation (AF), a curvilinear multi-electrode ablation (MEA) catheter has been reported to be successful to achieve pulmonary vein (PV) isolation. However, this approach has not been compared prospectively with conventional PV isolation (CPVI) using a standard circular mapping catheter and 3D electro-anatomic mapping. In this prospective non-randomized study, we compared the efficacy of these two techniques. METHODS: Of 185 consecutive patients, age 54.6 ± 10.1 years, with symptomatic paroxysmal AF (PAF), 96 patients underwent PV isolation by CPVI and 89 patients underwent MEA to isolate the PVs. CPVI was performed by encircling the left- and right-sided PVs. During MEA, the PV ablation catheter (Medtronic, USA) was used to isolate PVs with duty-cycled radiofrequency energy. RESULTS: The mean procedure time was 171.73 ± 52.87 min for CPVI and 133.25 ± 37.99 min for MEA, respectively (P < 0.001). The mean fluoroscopy time was 31.07 ± 14.97 for CPVI and 30.07 ± 11.45 min for MEA (P = 0.651). At 12 months, 80% of patients who underwent CPVI and 82% of patients who underwent MEA were free of symptomatic PAF off antiarrhythmic drug therapy (P = 0.989). Among the variables of age, gender, duration and frequency of PAF, left ventricular ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size was an independent predictor of recurrent PAF. Left atrial flutter occurred after CPVI in two patients and after MEA ablation in three patients. CONCLUSION: In patients undergoing catheter ablation for PAF, MEA and CPVI proved equally efficacious.
Rypko J Beukema; Arif Elvan; Jaap Jan J Smit; Peter Paul H M Delnoy; Anand R Ramdat Misier; Vivek Reddy
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-23
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  -     ISSN:  1572-8595     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011, JW, Zwolle, The Netherlands.
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