Ablation of persistent atrial fibrillation using multielectrode catheters and duty-cycled radiofrequency energy.
OBJECTIVE
The purpose of this study was to assess the efficacy and safety of a novel, multielectrode, duty-cycled radiofrequency ablation (RFA) system for long-standing persistent atrial fibrillation (AF).


BACKGROUND
RFA for persistent AF remains a lengthy and challenging procedure.


METHODS
In 5 European centers, 50 patients with long-standing persistent AF underwent RFA. A circular pulmonary vein (PV) ablation catheter was used for PV isolation. Complex fractionated atrial electrograms were targeted at the interatrial septum using a multiarray septal ablation catheter and in the left atrium using a multiarray ablation catheter.


RESULTS
During a mean total procedure time of 155 +/- 40 min, complete PV isolation and complex fractionated atrial electrogram ablation were achieved in all patients. In 50% of patients, redo ablation was performed using the same strategy and technology. There were no device-related adverse events. At 6 months, a 7-day Holter electrocardiogram showed >80% AF reduction in 40 of 50 patients (80%), and 32 of 50 (64%) were off antiarrhythmic drugs. At 20 +/- 4 months after the last procedure, 31 of 47 patients (66%) had a >80% reduction in AF burden, with 21 patients (45%) free of AF and off antiarrhythmic drugs.


CONCLUSIONS
This initial 50-patient multicenter study demonstrates a 80% short-term and 66% success rate at 20 months, with a low complication rate and a relatively short procedure time in patients with persistent AF using 3 anatomically specific multielectrode ablation catheters and low-energy duty-cycled radiofrequency energy.
Cardiovascular Center, Clinic im Park, Zurich, Switzerland. christoph.scharf@gmail.com
Christoph
C
Scharf
Lucas
L
Boersma
Wyn
W
Davies
Prapa
P
Kanagaratnam
Nicholas S
NS
Peters
Vince
V
Paul
Edward
E
Rowland
Andrew
A
Grace
Simon
S
Fynn
Lam
L
Dang
Hakan
H
Oral
Fred
F
Morady
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D013997:Time Factors