title: Combined circular multielectrode catheter and point-by-point ablation is superior to point-by-point ablation alone in eliminating atrial fibrillation.
abstract: BACKGROUND
  Besides conventional point-by-point ablation, novel multielectrode catheters emerge for ablation of atrial fibrillation (AF). We sought to evaluate the clinical utility of a pulmonary vein (PV) isolation approach combining the advantages of both technologies.
  
  
  METHODS
  The study included 240 consecutive AF patients (60±11 years, 68% males, 62% paroxysmal). In the combined ablation group (n=120), PV isolation was performed with a circular multielectrode catheter (PVAC, Medtronic Ablation Frontiers) and completed by conventional point-by-point ablation (NaviStar ThermoCool Catheter, Lasso/CARTO technology, Biosense Webster). In the point-by-point ablation group (n=120), PV isolation was performed with point-by-point ablation alone.
  
  
  RESULTS
  Complete 1-year ablation success (freedom from any atrial arrhythmia off antiarrhythmic drugs) was more frequently observed in the combined ablation group (58.0% versus 43.3%, hazard ratio 1.72, 95% confidence interval 1.19-2.48, p=0.004). Also clinical success (≥90% reduction of arrhythmia burden on/off antiarrhythmic drugs) was significantly associated with the combined ablation approach (p=0.001). These associations remained significant after multivariable adjustment (both p≤0.005) and were not dependent on the type of AF. The rate of major adverse events (3.3% versus 2.5%) and the procedure time did not differ between groups. The fluoroscopy time, however, was significantly shorter in the combined ablation group (p<0.001) reflecting the reduced need for radiation during multielectrode catheter ablation.
  
  
  CONCLUSIONS
  A combined PV isolation approach based on multielectrode catheter ablation and complementary point-by-point ablation is superior to point-by-point ablation alone and reveals to be safe. A potential explanation for these findings is the improved durability of ablation lesion after the combined ablation approach.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Austria. Electronic address: bernhard.richter@meduniwien.ac.at.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Richter
authors.forename: Marianne
authors.initials: M
authors.lastname: Gwechenberger
authors.forename: Michael
authors.initials: M
authors.lastname: Kriegisch
authors.forename: Sulaima
authors.initials: S
authors.lastname: Albinni
authors.forename: Manfred
authors.initials: M
authors.lastname: Marx
authors.forename: Heinz D
authors.initials: HD
authors.lastname: Gössinger
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Multielectrode catheter ablation; Point-by-point ablation; Pulmonary vein isolation; Success