Comparison between anatomical and integrated approaches to atrial fibrillation ablation: adjunctive role of electrical pulmonary vein disconnection.
BACKGROUND
The aim of this study was to compare the outcome of anatomical pulmonary vein (PV) radiofrequency (RF) ablation with that of an integrated approach (anatomical with electrophysiological confirmation of PV disconnection).


METHODS
Sixty consecutive patients affected by drug-refractory paroxysmal (39), persistent (13), and permanent (8) atrial fibrillation (AF) were assigned to an anatomical (group A: 30 patients; 25 male, 5 female, mean age: 55 +/- 7 years) or integrated approach (group B: 30 patients; 26 male, 4 female, mean age: 52 +/- 9 years). In all cases, RF ablation was performed by means of the Carto system in order to anatomically create circumferential lines around PVs. In group B, the persistence of PV potentials was then assessed with a multipolar circular catheter. If PV potentials persisted, RF pulses targeting the electrophysiological breakthroughs were delivered to disconnect PVs.


RESULTS
Total procedure duration, fluoroscopy time, and RF delivery time were similar in both groups: 227 +/- 43, 50 +/- 23, and 43 +/- 16 minutes (group A); 232 +/- 32, 55 +/- 15, and 42 +/- 10 minutes (group B), respectively (ns). One asymptomatic PV stenosis and one pericardial effusion occurred in group A and B, respectively. After 15.4 +/- 7.4 months, 17 (57%) group A patients and 25 (83%) group B patients were in stable sinus rhythm (P = 0.02) (RR 1.78; 95% CI: 1.7-2.9).


CONCLUSIONS
PV ablation by means of an integrated anatomical and electrophysiological approach seems more effective than a purely anatomical RF ablation approach. Electrophysiological confirmation of PV disconnection could be a useful marker of successful RF treatment of AF.
Mantovan
Roberto
R
Cardiovascular Department, Ospedale Regionale Santa Maria dei Battuti, Treviso, Italy. r.mantovan@serenacom.net
Verlato
Roberto
R
Calzolari
Vittorio
V
Baccillieri
Stella
S
De Leo
Alessandro
A
Turrini
Pietro
P
Pastore
Giovanni
G
Crosato
Martino
M
Ramondo
Angelo
A
Stritoni
Paolo
P
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D003251:Constriction, Pathologic; D004594:Electrophysiology; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology*; D013997:Time Factors