title: Pulmonary vein isolation to treat paroxysmal atrial fibrillation: conventional versus multi-electrode radiofrequency ablation.
abstract: OBJECTIVE
  For patients with symptomatic atrial fibrillation (AF), a curvilinear multi-electrode ablation (MEA) catheter has been reported to be successful to achieve pulmonary vein (PV) isolation. However, this approach has not been compared prospectively with conventional PV isolation (CPVI) using a standard circular mapping catheter and 3D electro-anatomic mapping. In this prospective non-randomized study, we compared the efficacy of these two techniques.
  
  
  METHODS
  Of 185 consecutive patients, age 54.6 ± 10.1 years, with symptomatic paroxysmal AF (PAF), 96 patients underwent PV isolation by CPVI and 89 patients underwent MEA to isolate the PVs. CPVI was performed by encircling the left- and right-sided PVs. During MEA, the PV ablation catheter (Medtronic, USA) was used to isolate PVs with duty-cycled radiofrequency energy.
  
  
  RESULTS
  The mean procedure time was 171.73 ± 52.87 min for CPVI and 133.25 ± 37.99 min for MEA, respectively (P < 0.001). The mean fluoroscopy time was 31.07 ± 14.97 for CPVI and 30.07 ± 11.45 min for MEA (P = 0.651). At 12 months, 80% of patients who underwent CPVI and 82% of patients who underwent MEA were free of symptomatic PAF off antiarrhythmic drug therapy (P = 0.989). Among the variables of age, gender, duration and frequency of PAF, left ventricular ejection fraction, left atrial size, structural heart disease, and the ablation technique, only an increased left atrial size was an independent predictor of recurrent PAF. Left atrial flutter occurred after CPVI in two patients and after MEA ablation in three patients.
  
  
  CONCLUSIONS
  In patients undergoing catheter ablation for PAF, MEA and CPVI proved equally efficacious.
authors.affiliation: Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011, JW, Zwolle, The Netherlands.
authors.forename: Rypko J
authors.initials: RJ
authors.lastname: Beukema
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
authors.forename: Jaap Jan J
authors.initials: JJ
authors.lastname: Smit
authors.forename: Peter Paul H M
authors.initials: PP
authors.lastname: Delnoy
authors.forename: Anand R Ramdat
authors.initials: AR
authors.lastname: Misier
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation / Q000379:methods*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome