Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies.
OBJECTIVE
We conducted this study to compare the efficacy and safety of different catheter ablation technologies and of distal versus ostial pulmonary veins (PV) isolation using the circular mapping technique.


BACKGROUND
Electrical isolation of the PVs in patients with atrial fibrillation (AF) remains a technical challenge.


METHODS
Two hundred eleven patients (163 men; mean age 53 +/- 11 years) with symptomatic AF were included in this study. In the first 21 patients (group 1), distal isolation (> or = 5 mm from the ostium) was achieved targeting veins triggering AF. In the remaining 190 patients (group 2), ostial isolation of all PVs was performed using 4-mm tip (47 patients), 8-mm tip (21 patients), or cooled-tip (122 patients) ablation catheters.


RESULTS
Distal isolation was able to eliminate premature atrial contractions (PACs) and AF in six of 21 patients (29%) and 10 of 34 PVs. After a mean follow-up time of 6 +/- 4 months, no patients treated with the 8-mm tip catheter experienced recurrence of AF, whereas 21% (10 of 47 patients) and 15% (18 of 122 patients) of the patients ablated with the 4-mm tip and the cooled-tip ablation catheters experienced recurrence of AF after a mean follow-up of 10 +/- 3 and 4 +/- 2 months, respectively. Significant complications including stroke, tamponade, and severe stenosis occurred in 3.5% (8/211) of patients.


CONCLUSIONS
Catheter technologies designed to achieve better lesion size appeared to have a positive impact on procedure time, fluoroscopy time, number of lesions, and overall efficacy. Although distal isolation can be achieved with fewer lesions, ostial isolation is required in the majority of patients to eliminate arrhythmogenic PACs and AF.
Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Nassir F
NF
Marrouche
Thomas
T
Dresing
Christopher
C
Cole
Dianna
D
Bash
Eduardo
E
Saad
Krzysztof
K
Balaban
Stephen V
SV
Pavia
Robert
R
Schweikert
Walid
W
Saliba
Ahmed
A
Abdul-Karim
Ennio
E
Pisano
Raffaele
R
Fanelli
Patrick
P
Tchou
Andrea
A
Natale
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D002940:Circadian Rhythm / Q000502:physiology; D022062:Electrophysiologic Techniques, Cardiac; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011183:Postoperative Complications / Q000209:etiology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome