title: Experience of atrial fibrillation ablation in a new cardiac centre using three-dimensional mapping and multielectrode duty-cycled radiofrequency ablation.
abstract: BACKGROUND
  Catheter ablation is widely used to treat symptomatic atrial fibrillation (AF) refractory to drug therapy; and can be facilitated by a number of different techniques.
  
  
  OBJECTIVE
  To evaluate our performance as a new centre for AF ablation and to evaluate the efficacy of different AF ablation techniques.
  
  
  METHODS
  We employed three techniques in AF ablations; the three-dimensional (3D) mapping approaches (CARTO or Ensite NavX) or multielectrode catheter duty-cycled radiofrequency ablation (pulmonary vein ablation catheter [PVAC]). The immediate restoration of sinus rhythm was considered as acute success; while success at 6 months was determined by the maintenance of sinus rhythm on Holter monitoring.
  
  
  RESULTS
  Between March 2008 and March 2010, 109 patients underwent AF ablations (mean age: 58 years; 72% male). Six-month success rates did not differ significantly between CARTO and NavX (40% vs 38%; P=0.81), but the PVAC group achieved greater success than the two 3D-mapping groups combined (68% vs 39%; P=0.004). Paroxysmal AF patients demonstrated greater 6-month success than persistent AF patients (P=0.005); and although the ratio of paroxysmal to persistent AF patients was slightly higher among the PVAC group, logistic regression confirmed PVAC and paroxysmal AF as predictors of success. Single-procedure success at 6 months was 48%. Including redo-ablations, some performed beyond the study period, our overall success rate at 6 months was 65%. Four patients experienced complications, but there were no deaths.
  
  
  CONCLUSIONS
  Despite being a new centre with relative inexperience, we achieved success rates comparable to those of established tertiary centres. PVAC performed significantly better than the two 3D-mapping approaches.
authors.affiliation: Department of cardiac electrophysiology, Essex cardiothoracic centre, Nethermayne, Basildon SS16 5NL, UK. alfredwaikah@gmail.com
authors.forename: Wai Kah
authors.initials: WK
authors.lastname: Choo
authors.forename: David
authors.initials: D
authors.lastname: Farwell
authors.forename: Stuart
authors.initials: S
authors.lastname: Harris
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D002300:Cardiac Care Facilities; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003198:Computer Simulation; D004566:Electrodes; D056149:Epicardial Mapping; D004867:Equipment Design; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins; D012189:Retrospective Studies; D016896:Treatment Outcome