Randomized comparison of bipolar versus unipolar plus bipolar recordings during segmental ostial ablation of pulmonary veins.
BACKGROUND
Segmental ostial ablation to isolate pulmonary veins is guided by pulmonary vein potentials. The aim of this prospective randomized study was to compare the utility of unipolar plus bipolar electrograms versus only bipolar electrograms as a guide for segmental ablation to isolate the pulmonary veins in patients with atrial fibrillation.


RESULTS
Isolation of the left superior, right superior, and left inferior pulmonary veins was attempted in 44 patients (35 men and 9 women; mean age 54 +/- 10 years) with paroxysmal atrial fibrillation. A decapolar Lasso catheter was positioned in the pulmonary veins, near the ostium, and a conventional ablation catheter was used for segmental ablation aimed at elimination of all pulmonary vein potentials. One hundred fourteen pulmonary veins were randomly assigned for ostial ablation guided by either bipolar or unipolar plus bipolar recordings. Electrical isolation was achieved in 51 (96%) of 53 pulmonary veins randomized to the bipolar approach, and 57 (93%) of 61 pulmonary veins randomized to the unipolar plus bipolar approach (P = 0.7). In the unipolar plus bipolar group, the total duration of radiofrequency energy needed to achieve isolation, 5.5 +/- 2.8 minutes/vein, was significant shorter than in the bipolar group, 7.6 +/- 4.1 minutes/vein (P < 0.01). Mean procedure and fluoroscopy durations per vein were 19% to 28% shorter in the unipolar plus bipolar group.


CONCLUSIONS
Segmental ostial ablation to isolate the pulmonary veins can be achieved more efficiently and with less radiofrequency energy when guided by both unipolar and bipolar recordings than by bipolar recordings alone.
Tada
Hiroshi
H
Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0022, USA.
Oral
Hakan
H
Knight
Bradley P
BP
Ozaydin
Mehmet
M
Chugh
Aman
A
Scharf
Christoph
C
Hassan
Sohail
S
Greenstein
Radmira
R
Pelosi
Frank
F
Strickberger
S Adam
SA
Morady
Fred
F
D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery; D017115:Catheter Ablation / Q000592:standards; D004562:Electrocardiography / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000209:etiology; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome