title: Circumferential pulmonary vein ablation: does use of a circular mapping catheter improve results? A prospective randomized study.
abstract: BACKGROUND
  The best method for performing atrial fibrillation (AF) ablation is still under debate. The importance of using a circular mapping (CM) catheter for assessing isolation of the pulmonary vein (PV) antrum on the outcome of the procedure has not been clearly established.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate whether use of a CM catheter improves the arrhythmia-free proportion after circumferential pulmonary vein ablation (CPVA).
  
  
  METHODS
  A series of 146 consecutive patients (83% males, age 53 +/- 10 years, 53% paroxysmal AF) were randomized to two ablation strategies. In both groups, ipsilateral PV encirclement was performed until disappearance or dissociation of the local electrogram within the surrounded area. In the first group, only the radiofrequency catheter was used to both map and ablate (CPVA group, n = 73). In the other group, a CM catheter was added to assess the electrical activity of the PV antrum (CPVA-CM group, n = 73). An ablation line along the left atrial roof was also created in all patients.
  
  
  RESULTS
  Procedural and fluoroscopic times were longer in the CPVA-CM group (P <.05). Severe procedure-related complications occurred in 1 (1.4%) patient in the CPVA group and in 3 (4.1%) patients in the CPVA-CM group (P = .317). After mean follow-up of 9 +/- 3 months, 31 (42.5%) patients in the CPVA group and 47 (64.4%) patients in the CPVA-CM group were arrhythmia-free without antiarrhythmic medication (P = .008).
  
  
  CONCLUSIONS
  Use of a CM catheter to ensure isolation of the PV antrum improved the success of CPVA but increased some procedural requirements.
authors.affiliation: Arrhythmia Section, Thorax Institute, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Catalonia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Tamborero
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Eduard
authors.initials: E
authors.lastname: Guasch
authors.forename: Jose
authors.initials: J
authors.lastname: Rios
authors.forename: Mercedes
authors.initials: M
authors.lastname: Nadal
authors.forename: Maria
authors.initials: M
authors.lastname: Matiello
authors.forename: David
authors.initials: D
authors.lastname: Andreu
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D016001:Confidence Intervals; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D055502:Secondary Prevention; D016896:Treatment Outcome