Pulmonary vein isolation by duty-cycled bipolar and unipolar antrum ablation using a novel multielectrode ablation catheter system: first clinical results
The electrical disconnection of the pulmonary veins (PV) plays an important role in the ablation strategy of paroxysmal atrial fibrillation (PAF). Circumferential antral ablation with a conventional ablation technique using a steerable ablation catheter is sometimes difficult to perform and does not always result in isolation of the targeted PV.
Patients with symptomatic PAF were treated with a novel circular mapping/ablation catheter (PVAC). Ablation was performed in the antral region of the PV with a power-modulated bipolar/unipolar RF generator using 8–10 W until isolation of the vein was achieved. Seven-day Holter monitor recordings were performed off antiarrhythmic drugs at 3 and 6 months after the initial procedure. A subgroup of patients had received an implantable recorder before ablation, and the device was interrogated at the same time. The primary objective of this study is acute isolation of the targeted PV, and the second objective is clinical efficacy with a short-term follow-up.
In 73 patients, 290 PV could be reached with the PVAC. Antral ablation was performed in 244 PV showing PV potentials. Acutely, 243 PV (99%) were isolated with the PVAC after 21 ± 7 energy applications per patient with a mean fluoroscopy time of 20 ± 11 min. Total procedure time was 122 ± 27 min. No complications were observed. Follow-up at 3 and 6 months showed freedom from AF in 61 of 73 (84%) patients and 38 of 45 patients (85%), respectively, off antiarrhythmic drugs.
PV isolation by duty-cycled unipolar/bipolar RF ablation can be effectively and safely performed with a circular, decapolar catheter. Clinical results at 3 and 6 months after ablation are encouraging with the need for longer follow-up intervals.
KeywordsAtrial fibrillation Catheter ablation Pulmonary vein isolation Unipolar/bipolar ablation Duty-cycled ablation
- 3.Scharf, C., Boersma, L. V. A., & Kanagaratnam, P. (2008). Long term efficacy when using multi-array catheters and phased radiofrequency energy for ablation of chronic atrial fibrillation (abstract). Journal of the American College of Cardiology, 51, A8.Google Scholar
- 4.Michaud, G., Martin, D., & John, R. (2008). Safety using novel multi-array catheters and phased radiofrequency energy in left atrial ablation for persistent atrial fibrillation (abstract). Heart Rhythm, 5(Suppl), S313–S314.Google Scholar
- 5.Wijffels, M. C., Oosterhout, M., & Vos, M. (2008). Characterization of atrial lesions using multipolar ablation catheters in pigs (abstract suppl). European Heart Journal, 29, 412.Google Scholar
- 6.Iwasa, A., Storey, A., Tashakkor, B., & Feld, K. (2003). Identification of pulmonary vein potentials by differential site atrial pacing in patients with paroxysmal atrial fibrillation: enhanced detection by pulmonary vein pacing. Journal of Cardiovascular Electrophysiology, 14, 1311–1318.CrossRefPubMedGoogle Scholar
- 9.Arentz, T., von Rosenthal, J., Weber, R., Burkle, G., Blum, T., Stockinger, J., et al. (2005). Effects of circumferential ostial radiofrequency lesions on pulmonary vein activation recorded with a multipolar basket catheter. Journal of Cardiovascular Electrophysiology, 16, 302–308.CrossRefPubMedGoogle Scholar
- 16.Verma, A., Patel, D., Famy, T., Martin, D. O., Burkhardt, J. D., Elayi, S. C., et al. (2007). Efficacy of adjuvant anterior left atrial ablation during intracardiac echocardiography-guided pulmonary vein antrum isolation for atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18, 151–156.CrossRefPubMedGoogle Scholar
- 19.Reddy, V. Y., Houghtaling, C., Fallon, J., Fischer, G., Farr, N., Clarke, J., et al. (2004). Use of a diode laser balloon ablation catheter to generate circumferential pulmonary venous lesions in an open-thoracotomy caprine model. Pacing and Clinical Electrophysiology, 27, 52–57.CrossRefPubMedGoogle Scholar
- 21.Arruda, M. S., He, D. S., Friedman, P., Nakagawa, H., Bruce, C., Azegami, K., et al. (2007). A novel mesh electrode catheter for mapping and radiofrequency delivery at the left atrium–pulmonary vein junction: a single-catheter approach to pulmonary vein antrum isolation. Journal of Cardiovascular Electrophysiology, 18, 206–211.CrossRefPubMedGoogle Scholar
- 26.Hocini, M., Sanders, P., Jais, P., Hsu, L. F., Weerasoriya, R., Scavee, C., et al. (2005). Prevalence of pulmonary vein disconnection after anatomical ablation for atrial fibrillation: consequences of wide atrial encircling of the pulmonary veins. European Heart Journal, 26, 696–704.CrossRefPubMedGoogle Scholar
- 28.Karch, M. R., Zrenner, B., Deisenhofer, I., Schreieck, J., Ndrepepa, G., Dong, J., et al. (2005). Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation, 111, 2875–2880.CrossRefPubMedGoogle Scholar
- 29.Van Belle, Y., Janse, P., Rivero-Ayerza, M. J., Thornton, A. S., Jessurun, E. R., Theuns, D., et al. (2007). Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome. European Heart Journal, 28, 2231–2237.CrossRefPubMedGoogle Scholar
- 31.Fredersdorf, S., Weber, S., Jilek, C., Heinicke, N., VON Bary, C., Jungbauer, C., et al. (2009). Safe and rapid isolation of pulmonary veins using a novel circular ablation catheter and duty-cycled RF generator. Journal of Cardiovascular Electrophysiology, 20, 1097–1101.Google Scholar