title: Can segmental pulmonary vein ablation reduce the recurrence of atrial fibrillation when using a higher RF power, larger tip electrode catheter, and additional RF deliveries?: the limitations of point-by-point RF ablation.
abstract: The aim of this study was to investigate whether segmental ostial catheter ablation (SOCA) designed to prevent the electrical connections (ECs) between the left atrium and pulmonary veins (PVs) might help increase the efficacy of SOCA in paroxysmal atrial fibrillation (PAF). PV mapping and successful SOCA were performed with a basket catheter in 108 consecutive patients with PAF. Radiofrequency energy was delivered using a maximum output of 30 W with a 4 mm tip catheter (group I; 47) or 40 W with an 8 mm tip catheter (group II; 61). Only in the group II patients were additional radiofrequency deliveries to the specific sites where the ECs tended to recover performed after successful SOCA. After the first procedure, PAF recurred in 47% of the group I patients and 32% of the group II patients. In all 27 patients who underwent repeat procedures, EC recoveries were observed more frequently in group I than in group II (69% versus 49%; P < 0.05). After multiple procedures, there was more freedom from PAF in group II (84%) than in group I (66%) (P < 0.05). SOCA with a higher RF power, larger tip catheter, and additional RF deliveries could achieve a more effective SOCA.
authors.affiliation: Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Murakami
authors.forename: Taro
authors.initials: T
authors.lastname: Okada
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Okamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Junji
authors.initials: J
authors.lastname: Toyama
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Naoya
authors.initials: N
authors.lastname: Tsuboi
authors.forename: Teruo
authors.initials: T
authors.lastname: Ito
authors.forename: Masahiro
authors.initials: M
authors.lastname: Muto
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kondo
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirai
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D002404:Catheterization; D004566:Electrodes; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D013318:Stroke Volume