Catheter ablation for paroxysmal atrial fibrillation: a randomized comparison between multielectrode catheter and point-by-point ablation.
BACKGROUND
Catheter ablation for paroxysmal atrial fibrillation is widely used for patients with drug-refractory paroxysms of arrhythmia. Recently, novel technologies have been introduced to the market that aim to simplify and shorten the procedure.


OBJECTIVE
To compare the clinical outcome of pulmonary vein (PV) isolation using a multipolar circular ablation catheter (PVAC group), with point-by-point PV isolation using an irrigated-tip ablation catheter and the CARTO mapping system (CARTO group; CARTO, Biosense Webster, Diamond Bar, CA, USA).


METHODS
Patients with documented PAF were randomized to undergo PV isolation using PVAC or CARTO. Atrial fibrillation (AF) recurrences were documented by serial 7-day Holter monitoring.


RESULTS
One hundred and two patients (mean age 58 ± 11 years, 68 men) were included in the study. The patients had comparable baseline clinical characteristics, including left atrial dimensions and left ventricular ejection fraction, in both study arms (PVAC: n = 51 and CARTO: n = 51). Total procedural and fluoroscopic times were significantly shorter in the PVAC group (107 ± 31 minutes vs 208 ± 46 minutes, P < 0.0001 and 16 ± 5 minutes vs 28 ± 8 minutes, P < 0.0001, respectively). The AF recurrence was documented in 23% and 29% of patients in the PVAC and CARTO groups, respectively (P = 0.8), during the mean follow-up of 200 ± 13 days. No serious complications were noted in both study groups.


CONCLUSIONS
Clinical success rates of PV isolation are similar when using multipolar circular PV ablation catheter and point-by-point ablation with a three-dimensional (3D) navigation system in patients with PAF, and results in shorter procedural and fluoroscopic times with a comparable safety profile.
Heart and Vascular Centre, České Budějovice Hospital, České Budějovice, Czech Republic. alanbulava@seznam.cz
Alan
A
Bulava
Jiří
J
Haniš
David
D
Sitek
Ondřej
O
Ošmera
Dan
D
Karpianus
Michal
M
Snorek
Kateřina
K
Rehoušková
František
F
Toušek
Ladislav
L
Pešl
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods*; D018153:Czech Republic; D004566:Electrodes; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome