Efficacy of multi-electrode duty-cycled radiofrequency ablation for pulmonary vein disconnection in patients with paroxysmal and persistent atrial fibrillation
Open Access
- 25 February 2010
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in EP Europace
- Vol. 12 (4), 502-507
- https://doi.org/10.1093/europace/euq023
Abstract
A novel multi-electrode pulmonary vein ablation catheter (PVAC) combining circular mapping and duty-cycled multi-electrode radiofrequency (RF) energy delivery has been developed to map and isolate the pulmonary veins (PVs). The aim of this study was to assess the efficacy of multi-electrode RF ablation using the PVAC device. A total of 102 consecutive patients, age 57.9 ± 9.6 years, with paroxysmal or persistent drug refractory atrial fibrillation (AF) were referred for ablation. All patients had documented AF episodes with an AF duration of 9.3 ± 7.5 years (range 1.5–25). The mean total procedure time was 139.30 ± 37.72 (median 135, range 115–172). The mean fluoroscopy time required for PVAC ablation was 17 ± 12 min (median 16, range 12–33) and the total fluoroscopy time was 32.1 ± 11.3 min (median 29, range 25–39). The mean multi-electrode RF ablation time required to achieve complete PV isolation was 31 ± 6.7 min (range 16–51). In eight patients with persistent AF, additional ablations were performed to defragment septal and posterior part of the left atrium. In five patients additional RF ablations using conventional catheters were necessary. After multi-electrode duty-cycled RF ablation, 62 of 102 (60.8%) patients were in sustained sinus rhythm without anti-arrhythmic drugs. The mean follow-up duration was 12.2 ± 3.9 months (range 6–15). This novel multi-electrode ablation technique can be used for PV isolation and left atrium ablation with a relatively low medium-term success rate after the first ablation of ∼61%. Larger studies with longer follow-up are required to evaluate the efficacy and whether multi-electrode RF ablation is associated with a different complication rate compared with standard PV isolation.This publication has 18 references indexed in Scilit:
- First Experiences for Pulmonary Vein Isolation with the High‐Density Mesh Ablator (HDMA): A Novel Mesh Electrode Catheter for Both Mapping and Radiofrequency Delivery in a Single UnitJournal of Cardiovascular Electrophysiology, 2009
- Radiofrequency ablation of paroxysmal atrial fibrillation by mesh catheterJournal of Interventional Cardiac Electrophysiology, 2009
- Pulmonary vein isolation by duty-cycled bipolar and unipolar radiofrequency energy with a multielectrode ablation catheterHeart Rhythm, 2008
- Catheter Ablation Versus Antiarrhythmic Drugs for Atrial FibrillationCirculation, 2008
- Potential interference of small neodymium magnets with cardiac pacemakers and implantable cardioverter-defibrillatorsHeart Rhythm, 2007
- A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation: The APAF StudyJournal of the American College of Cardiology, 2006
- Endpoints for ablation of atrial fibrillationHeart Rhythm, 2006
- Complete Isolation of Left Atrium Surrounding the Pulmonary VeinsCirculation, 2004
- Specific linear left atrial lesions in atrial fibrillation: Intraoperative radiofrequency ablation using minimally invasive surgical techniquesJournal of the American College of Cardiology, 2002
- Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary VeinsThe New England Journal of Medicine, 1998