title: Mapping and isolation of the pulmonary veins using the PVAC catheter.
abstract: OBJECTIVE
  We aimed to investigate the feasibility, efficacy, and safety of the pulmonary vein ablation catheter (PVAC) catheter (a novel multielectrode catheter using duty-cycled bipolar and unipolar radiofrequency energy, Medtronic, Minneapolis, MN, USA) to completely isolate the pulmonary veins (PVs).
  
  
  METHODS
  Twenty-seven patients (60 +/- 8 years) with paroxysmal atrial fibrillation (AF) underwent PV isolation with the PVAC catheter. PVAC was used for both mapping and isolation of the PVs (PVAC-guided ablation). After PVAC ablation, presence/absence of PV potentials (PVP) was verified using a conventional circular mapping catheter. In case of residual PVP on the circular catheter, PVAC ablation was continued.
  
  
  RESULTS
  After PVAC-guided ablation 99 of 106 PVs (93%) and 21 of 27 patients (78%) were proven to be isolated. Failure to isolate was due to a mapping failure in four right-sided PVs and a true ablation failure in three right-sided PVs. After continued PVAC ablation, 103 of 106 PVs (97%) and 25 of 27 patients (93%) were shown to be isolated. The total procedural time from femoral vein access to complete catheter withdrawal was 176 +/- 25 minutes. The actual dwelling-time of the PVAC within the left atrium was 102 +/- 37 minutes. Esophageal T degrees rise to >38.5 degrees occurred in nine of 19 monitored patients (47%).
  
  
  CONCLUSIONS
  (1) PVAC-guided ablation (i.e., mapping and ablation with a single catheter) results in isolation of all PVs in 73% of the patients. (2) An additional circular mapping catheter is required to increase complete isolation rate to 93% of the patients. (3) Given the esophageal T degrees rise in almost 50% of patients, safety precautions are needed.
authors.affiliation: Department of Cardiology, St-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium. mattias.duytschaever@azbrugge.be
authors.forename: Mattias
authors.initials: M
authors.lastname: Duytschaever
authors.forename: Wim
authors.initials: W
authors.lastname: Anne
authors.forename: Giorgi
authors.initials: G
authors.lastname: Papiashvili
authors.forename: Yves
authors.initials: Y
authors.lastname: Vandekerckhove
authors.forename: Rene
authors.initials: R
authors.lastname: Tavernier
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010791:Phrenic Nerve / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome