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Acute efficacy of contiguous versus temporally discontiguous point-by-point radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a randomized study

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Abstract

Purpose

Durable pulmonary vein (PV) isolation (PVI) determines the clinical success of catheter ablation for atrial fibrillation. In this randomized study, we investigated whether the temporally discontiguous deployment of ablation lesions adversely affected the acute efficacy of PVI.

Methods

Thirty-six consecutive patients with drug-refractory paroxysmal atrial fibrillation (aged 59 ± 11, 58% males) were randomized 1:1 to either discontiguous (D-PVI) or contiguous (C-PVI) encircling radiofrequency (RF) lesions around ipsilateral PVs. A contact force-sensing catheter was used targeting a final interlesion distance < 6 mm and the ablation index of 400–450 (anterior wall) and 300–350 (posterior wall). The study endpoint was defined as failure of first-pass PVI or acute PV reconnection during a waiting time (> 30 min) followed by adenosine challenge.

Results

The total RF time, number of RF lesions, and mean interlesion distance were comparable in both groups. Total endpoint rates were 1/36 (3%) in the D-PVI vs 4/36 (11%) in the C-PVI groups; P = 0.34 for superiority, P = 0.008 for non-inferiority. Adenosine-induced reconnection of right PVs was the only endpoint in the D-PVI group. In the C-PVI group, first-pass PVI failed in 2 right PVs and spontaneous reconnection occurred in 2 other circles (left and right PVs).

Conclusion

Temporally discontiguous deployment of RF lesions is not associated with lower procedural PVI efficacy when strict criteria for interlesion distance and ablation index are applied. The development of local edema around each ablation site does not prevent effective RF lesion formation at adjacent positions.

Trial registration

clinicaltrials.gov (NCT03332862).

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Availability of data and material

Available upon request.

Code availability

NA.

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Funding

Research Grant of the Ministry of Health of the Czech Republic — conceptual development of research organization, Grant Number: IN 00023001.

Ministerstvo Zdravotnictví Ceské Republiky

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Authors and Affiliations

  1. Institute for Clinical and Experimental Medicine, Prague, Czech Republic

    Bashar Aldhoon, Petr Peichl, Petr Konečný, Josef Kautzner & Dan Wichterle

  2. University Hospital Kralovske Vinohrady, Prague, Czech Republic

    Pavel Osmančík

  3. Third Faculty of Medicine, Charles University, Prague, Czech Republic

    Pavel Osmančík

  4. First Faculty of Medicine, Charles University, Prague, Czech Republic

    Dan Wichterle

Authors
  1. Bashar Aldhoon
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  2. Petr Peichl
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  3. Pavel Osmančík
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  4. Petr Konečný
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  5. Josef Kautzner
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  6. Dan Wichterle
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Ethics approval

This study was approved by the ethics committee at the institute for Clinical and Experimental Medicine and University Hospital Kralovske Vinohrady.

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The authors declare no competing interests.

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Aldhoon, B., Peichl, P., Osmančík, P. et al. Acute efficacy of contiguous versus temporally discontiguous point-by-point radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a randomized study. J Interv Card Electrophysiol 64, 661–667 (2022). https://doi.org/10.1007/s10840-021-01113-9

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  • DOI: https://doi.org/10.1007/s10840-021-01113-9

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