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Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation

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Abstract

Purpose

In ablation of atrial fibrillation, the single-ring method aims for isolation of the posterior wall of the left atrium (LA) including the pulmonary veins (PVs) but avoiding posterior LA lesions. The aim of this randomized prospective study was to evaluate safety and efficacy of remote magnetic navigation (RMN)-guided single-ring ablation strategy as compared to standard RMN-guided circumferential PV ablation (PVA).

Methods

Eighty consecutive patients undergoing PVA were enrolled prospectively and randomized equally into two study groups. RMN using the Stereotaxis system and open-irrigated 3.5-mm ablation catheters were used with a 3D mapping system in all procedures. Forty patients underwent RMN-guided single-ring ablation, and 40 patients received RMN-guided circumferential PVA.

Results

In the circumferential group, 3.3 ± 1.1 PVs were successfully isolated at the end of the procedure as compared to 3.1 ± 1.3 in the single-ring (box) group (p = 0.38). All patients in the box group required additional posterior lesions in order to achieve electrical isolation of the PVs. Single-ring ablation was associated with longer procedure duration (p = 0.01) and ablation time (p = 0.001). After a single procedure, the proportion of patients free of any atrial tachycardia (AT)/atrial fibrillation (AF) episode at 12-month follow-up was 57 % in the box group and 58 % in the circ group. Using RMN, only minor complications have been observed.

Conclusions

RMN-guided single-ring PVA provides comparable acute and long-term success rates as compared to RMN-guided circumferential PVA but requires additional posterior lesions to achieve PV isolation and increased procedure and ablation time. Procedural complication rates are low when using RMN.

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Conflict of interest

Drs. Vollmann and Zabel have received moderate grant support from Stereotaxis. The study was supported by an unrestricted research grant by Stereotaxis, Inc.

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Authors and Affiliations

  1. Division of Clinical Electrophysiology, Department of Cardiology and Pneumology, Heart Center, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany

    Christian Sohns, Leonard Bergau, Joachim Seegers, Lars Lüthje, Dirk Vollmann & Markus Zabel

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  1. Christian Sohns
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  2. Leonard Bergau
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  3. Joachim Seegers
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  4. Lars Lüthje
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  6. Markus Zabel
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Correspondence to Christian Sohns.

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Sohns, C., Bergau, L., Seegers, J. et al. Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation. J Interv Card Electrophysiol 41, 75–82 (2014). https://doi.org/10.1007/s10840-014-9915-x

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  • DOI: https://doi.org/10.1007/s10840-014-9915-x

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