Skip to main content

Advertisement

SpringerLink
Log in

First results and follow-up of a second-generation circular mapping and ablation catheter

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Pulmonary vein isolation with radiofrequency energy is widely used as a strategy for catheter ablation of atrial fibrillation (AF). Anatomically designed catheters have been developed to increase the efficiency of AF ablation procedures. The second-generation circular ablation catheter, PVAC GOLD, was re-designed to improve energy delivery and mitigate emboli. We investigated the procedural efficiency, biophysics, and chronic efficacy of PVAC GOLD in patients with AF.

Methods

We consecutively enrolled 40 patients (60 ± 11 years) with highly symptomatic, drug refractory AF. The first 20 patients were treated with the first-generation PVAC. The subsequent 20 patients were treated with the second-generation PVAC GOLD catheter. All patients were followed up at 3, 6, and 12 months.

Results

All 164 targeted PVs were successfully isolated. Ablations performed with PVAC GOLD showed a significant reduction in total number of ablations needed for PVI, fluoroscopy, and procedure times compared to PVAC (34.7 ± 7.0 vs. 27.0 ± 6.5; p = 0.009), fluoroscopy (29.5 ± 9.5 vs. 23.4 ± 7.0; p = 0.026), and procedure time (93.8 ± 18.9 vs. 83.1 ± 10.6; p = 0.033). PVAC GOLD showed improved biophysics including a reduction of low power ablations and an increase in mean effective energy delivery. At 12 months follow-up, AF recurrence rates were comparable in the two groups (35 vs. 30 %; p = 0.735). There were no adverse events.

Conclusions

The redesigned PVAC GOLD catheter demonstrates a reduction in radiofrequency ablation and procedure time and improved biophysics while maintaining chronic efficacy compared to the first-generation PVAC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wolf PA, Mitchell JB, Baker CS, Kannel WB, D’Agostino RB. Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med. 1998;158:229–34.

    Article  CAS  PubMed  Google Scholar 

  2. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm. 2012;9:632–96.

    Article  PubMed  Google Scholar 

  3. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812–22.

    Article  PubMed  Google Scholar 

  4. Boersma LV, Wijffels MC, Oral H, Wever EF, Morady F. Pulmonary vein isolation by duty-cycled bipolar and unipolar radiofrequency energy with a multielectrode ablation catheter. Heart Rhythm. 2008;5:1635–42.

    Article  PubMed  Google Scholar 

  5. Fredersdorf S, Weber S, Jilek C, Heinicke N, von Bary C, Jungbauer C, et al. Safe and rapid isolation of pulmonary veins using a novel circular ablation catheter and duty-cycled RF generator. J Cardiovasc Electrophysiol. 2009;20:1097–101.

    Article  PubMed  Google Scholar 

  6. von Bary C, Weber S, Dornia C, Eissnert C, Fellner C, Latzin P, et al. Evaluation of pulmonary vein stenosis after pulmonary vein isolation using a novel circular mapping and ablation catheter (PVAC). Circ Arrhythm Electrophysiol. 2011;4(5):630–6.

    Article  Google Scholar 

  7. Wieczorek M, Hoeltgen R, Akin E, Salili AR, Oral H, Morady F. Results of short-term and long-term pulmonary vein isolation for paroxysmal atrial fibrillation using duty-cycled bipolar and unipolar radiofrequency energy. J Cardiovasc Electrophysiol. 2010;21(4):399–405.

    Article  PubMed  Google Scholar 

  8. Gaita F, Leclercq JF, Schumacher B, Scaglione M, Toso E, Halimi F, et al. Incidence of silent cerebral thrombomembolic lesions after atrial fibrillation ablation may change according to technology used: comparison of irrigated radiofrequency, multipolar nonirrigated catheter and cryoballoon. J Cardiovasc Electrophysiol. 2011;2:961–8.

    Article  Google Scholar 

  9. Herrera Siklódy C, Deneke T, Hocini M, Lehrmann H, Shin DI, Miyazaki S, et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol. 2011;58(7):681–8.

    Article  PubMed  Google Scholar 

  10. Verma A, Debruyne P, Nardi S, Deneke T, DeGreef Y, Spitzer S, et al. L. Evaluation and reduction of asymptomatic cerebral embolism in ablation of atrial fibrillation, but high prevalence of chronic silent infarction: results of the evaluation of reduction of asymptomatic cerebral embolism trial. Circ Arrhythm Electrophysiol. 2013;6:835–42.

    Article  PubMed  Google Scholar 

  11. Haines DE, Stewart MT, Dahlberg S, Barka ND, Condie C, Fiedler GR, et al. Microembolism and catheter ablation I: a comparison of irrigated radiofrequency and multielectrode phased radiofrequency catheter ablation of pulmonary vein Ostia. Circ Arrhythm Electrophysiol. 2013;6(1):16–22.

    Article  PubMed  Google Scholar 

  12. Haines DE, Stewart MT, Barka ND, Kirchhof N, Lentz LR, Reinking NM, et al. Microembolism and catheter ablation II: effects of cerebral microemboli injection in a canine model. Circ Arrhythm Electrophysiol. 2013;6(1):23–30.

    Article  PubMed  Google Scholar 

  13. Haines DE, Strunk AR, Novichenok A, Kirchhof N, Stewart MT. The biophysics of passive convective cooling during catheter ablation with gold versus platinum electrodes and multielectrode phased radiofrequency energy delivery. J Cardiovasc Electrophysiol. 2015.

  14. De Greef Y, Dekker L, Boersma L, Murray S, Wieczorek M, Spitzer SG, et al. Low rate of asymptomatic cerebral embolism and improved procedural efficiency with the novel PVAC GOLD: Results of the PRECISION GOLD trial. Europace. 2016.

  15. Hocini M, Kirchhof NA, Condie C, Stewart MT. Strong correlation between RF biophysics, contact assessment, and lesion quality in a temperature-controlled, multi-electrode ablation system. Europace. 2014; 16(suppl 2);Abstract 136_80.

  16. Bulava A, Hanis J, Sitek D, Osmera O, Karpianus D, Snorek M, et al. Catheter ablation for paroxysmal atrial fibrillation: a randomized comparison between multielectrode catheter and point-by-point ablation. Pacing Clin Electrophysiol. 2010;33:1039–46.

    Article  PubMed  Google Scholar 

  17. Bittner A, Monnig G, Zellerhoff S, Pott C, Kobe J, Dechering D, et al. Randomized study comparing duty-cycled bipolar and unipolar radiofrequency with point-by-point ablation in pulmonary vein isolation. Heart Rhythm. 2011;8:1383–90.

    Article  PubMed  Google Scholar 

  18. McCready J, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J. Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial. Europace. 2014;16(8):1145–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. De Greef Y, Buysschaert I, Schwagten B, Stockman D, Tavernier R, Duytschaever M. Duty-cycled multi-electrode radiofrequency vs. conventional irrigated point-by-point radiofrequency ablation for recurrent atrial fibrillation: comparative 3-year data. Europace. 2014;16(6):820–5.

    Article  PubMed  Google Scholar 

  20. Gal P, Aarntzen AE, Smit JJ, Adiyaman A, Misier AR, Delnoy PP, et al. Conventional radiofrequency catheter ablation compared to multi-electrode ablation for atrial fibrillation. Int J Cardiol. 2014;176(3):891–5.

    Article  PubMed  Google Scholar 

  21. Lewalter T, Weiss C, Spencker S, Jung W, Haverkamp W, Willems S. Gold vs. platinum-iridium tip catheter for cavotricuspid isthmus ablation: the AURUM 8 study. Europace. 2011;13(1):102–8.

    Article  PubMed  Google Scholar 

  22. De Greef Y, Tavernier R, Schwagten B, De Keulenaer G, Stockman D, Duytschaever M. Impact of radiofrequency characteristics on acute pulmonary vein reconnection and clinical outcome after PVAC ablation. J Cardiovasc Electrophysiol. 2013;24(3):290–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinikum Bayreuth, Department of Cardiology and Electrophysiology, Bayreuth, Germany

    Stefan Weber, Martin Höher & Dominik Schultes

  2. University of Regensburg and Praxis für Kardiologie und Rhythmologie, Weichser Weg 5, 93059, Regensburg, Germany

    Stefan Weber

Authors
  1. Stefan Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Höher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dominik Schultes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Weber.

Ethics declarations

Written consent was obtained from all the patients, and the study protocol was approved by the institutional review board of Bayreuth Hospital.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weber, S., Höher, M. & Schultes, D. First results and follow-up of a second-generation circular mapping and ablation catheter. J Interv Card Electrophysiol 47, 213–219 (2016). https://doi.org/10.1007/s10840-016-0140-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-016-0140-7

Keywords

Search

Navigation