title: Circumferential pulmonary vein isolation and linear left atrial ablation as a single-catheter technique to achieve bidirectional conduction block: the pace-and-ablate approach.
abstract: BACKGROUND
  Pulmonary vein (PV) isolation has become a cornerstone for ablation of atrial fibrillation (AF). Circular mapping catheter (CMC)-guided techniques for detection of lesion gaps are challenging.
  
  
  OBJECTIVE
  The present study describes a new concept of circumferential PV ablation aiming at bidirectional conduction block based on simultaneous pacing and ablation through the tip of a single mapping/ablation catheter.
  
  
  METHODS
  A total of 147 patients with AF received circumferential PV ablation. In persistent AF, a posterior "box" lesion and a mitral isthmus line were added. All procedures were performed in sinus rhythm. Gaps within the left atrial (LA) ablation lines were detected and closed using voltage and pace mapping through the mapping/ablation catheter. Bidirectional conduction block was the procedural end point. Subsequently, the end point was validated by an independent electrophysiologist using a CMC.
  
  
  RESULTS
  Procedural and radiation time measured 188 +/- 55 and 37 +/- 15 min. Bidirectional PV conduction block (lack of PV potentials and lack of LA capture) was found in 140 of 147 (95%) patients with single mapping/ablation catheter and in 138 of 147 (94%) patients with CMC. Early PV reconduction was seen in 22 of 147 (15%) patients. After 12 months follow-up, 84% of the patients were free from AF and/or atrial macro-re-entrant tachycardia. The rate of reablations was 10% and 24% for patients with paroxysmal and persistent AF, respectively.
  
  
  CONCLUSIONS
  Pacing and ablation from the tip of the mapping/ablation catheter is feasible to detect and close gaps within long atrial ablation lines to consistently achieve bidirectional conduction block.
authors.affiliation: Department of Electrophysiology, University of Leipzig Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
authors.forename: Simon
authors.initials: S
authors.lastname: Kircher
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wetzel
authors.forename: Nicos
authors.initials: N
authors.lastname: Dagres
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.forename: Daniela
authors.initials: D
authors.lastname: Husser
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hilbert
authors.forename: Ruzbeh
authors.initials: R
authors.lastname: Zaker-Shahrak
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D016009:Chi-Square Distribution; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D018709:Statistics, Nonparametric; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome