title: Randomized study comparing duty-cycled bipolar and unipolar radiofrequency with point-by-point ablation in pulmonary vein isolation.
abstract: BACKGROUND
  Pulmonary vein (PV) electrical isolation is a therapeutic option in atrial fibrillation (AF). New technologies may reduce the complexity of the procedure.
  
  
  OBJECTIVE
  The aim of the present study was to compare immediate results and short-term efficacy of a new circular ablation catheter (PVAC) with a conventional point-by-point ablation.
  
  
  METHODS
  The prospective study enrolled 80 consecutive patients with paroxysmal AF or persistent AF, refractory to antiarrhythmic drugs, who were randomized to radiofrequency ablation using duty-cycled bipolar and unipolar radiofrequency by a decapolar circular catheter (PVAC group) or to point-by-point ablation supported by a 3-dimensional mapping system (3D group).
  
  
  RESULTS
  Forty patients per group were included. Mean age was 58 ± 10 years, 64% were male; 55% had paroxysmal AF, 45% had persistent AF. There were no significant differences between groups. Complete electrical isolation was reached in all but 1 PV, which was not isolated in the PVAC group because of phrenic nerve capture. Procedure and fluoroscopy times were lower in the PVAC group: 171 ± 40 minutes vs. 224 ± 27 minutes, P < .001; 26 ± 8 minutes vs. 35 ± 9 minutes, P < .001; respectively. There were no major complications. During a mean follow-up of 254 ± 99 days, 72% in the PVAC group and 68% in the 3D group were free of AF recurrences irrespective of the initial AF type (P = NS).
  
  
  CONCLUSIONS
  PVAC represents a safe alternative for PV isolation. It reduces both procedure and fluoroscopy time. The short- and middle-term efficacy is comparable to a conventional point-by-point antral ablation technique.
authors: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Münster, Münster, Germany.
authors: Alex
authors: A
authors: Bittner
authors: Gerold
authors: G
authors: Mönnig
authors: Stephan
authors: S
authors: Zellerhoff
authors: Christian
authors: C
authors: Pott
authors: Julia
authors: J
authors: Köbe
authors: Dirk
authors: D
authors: Dechering
authors: Peter
authors: P
authors: Milberg
authors: Kristina
authors: K
authors: Wasmer
authors: Lars
authors: L
authors: Eckardt
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome