title: Point-by-point pulmonary vein antrum isolation guided by intracardiac echocardiography and 3D mapping and duty-cycled multipolar AF ablation: effect of multipolar ablation on procedure duration and fluoroscopy time.
abstract: OBJECTIVE
  Pulmonary vein antrum isolation (PVAI) guided by intracardiac echocardiography and a roaming circular mapping catheter is an effective treatment modality for atrial fibrillation. Unfortunately, the complexity of this technique leads to long procedure times and high fluoroscopy exposure. Single-catheter multipolar ablation holds the promise to reduce these parameters. This study examined the effect of the conventional point-by-point PVAI with that of single-catheter multipolar ablation on the procedural characteristics and clinical outcomes of atrial fibrillation ablation.
  
  
  METHODS
  Referred patients underwent PVAI guided by a magnetic-based 3D mapping (CARTO 3(®) System; group 1) or duty-cycled multipolar AF ablation using the pulmonary vein ablation catheter (PVAC, group 2) between June 2010 and May 2011.
  
  
  RESULTS
  Data were analyzed from 19 patients in group 1 and 31 patients in group 2. There was no significant difference in the length of the procedure between the two groups (135 ± 26 vs 125 ± 25 min, P = 0.20). Patients who underwent ablation using PVAC spent significantly less time in the procedure room pre- and post-procedure than those who underwent conventional PVAI (205 ± 38 vs 179 ± 30 min, P = 0.02) and had a significantly shorter fluoroscopy exposure (50 ± 16 vs 36 ± 14 min, P = 0.003) and radiofrequency energy delivery time (54 ± 26 vs 32 ± 33 min, P = 0.02). No differences in safety and efficacy were seen between the groups.
  
  
  CONCLUSIONS
  Single-catheter multipolar AF ablation was associated with significantly lower fluoroscopy duration, radiofrequency energy delivery time, and the time the patient spent in the procedure room before and after ablation, although measured short-term clinical outcomes were similar.
authors.affiliation: Heart Rhythm Program, Southlake Regional Health Centre, 105-712 Davis Drive, Newmarket, ON, Canada, L3Y 8C3. y.khaykin@utoronto.ca
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Lauren
authors.initials: L
authors.lastname: Zarnett
authors.forename: Daniel
authors.initials: D
authors.lastname: Friedlander
authors.forename: Zaev A
authors.initials: ZA
authors.lastname: Wulffhart
authors.forename: Bonnie
authors.initials: B
authors.lastname: Whaley
authors.forename: David
authors.initials: D
authors.lastname: Giewercer
authors.forename: Bernice
authors.initials: B
authors.lastname: Tsang
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional