Mapping and isolation of the pulmonary veins using the PVAC catheter.
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.
Duytschaever
Mattias
M
Department of Cardiology, St-Jan Hospital Bruges, Ruddershove 10, Bruges, Belgium. mattias.duytschaever@azbrugge.be
Anne
Wim
W
Papiashvili
Giorgi
G
Vandekerckhove
Yves
Y
Tavernier
Rene
R
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