Wide circumferential versus individual isolation of pulmonary veins using the endoscopic ablation system.
BACKGROUND
The endoscopic ablation system (EAS) allows for effective pulmonary vein isolation (PVI). The feasibility of wide circumferential as compared to individual PVI using the EAS has not been formally assessed.


METHODS
Patients with paroxysmal or short-persistent atrial fibrillation were assigned to individual PVI (group A) or wide circumferential PVI (group B). In group B, circumferential PVI was attempted only if the ipsilateral inferior PV was visualized while the ablation system targeted the superior PV and vice versa. Otherwise, individual PVI was performed.


RESULTS
A total of 38 patients were enrolled (Group A: 20 patients, age 61 ± 7 years, LA-diameter 43 ± 5 mm; Group B: 18 patients, age 62 ± 10 years, LA-diameter 43 ± 4 mm). In group A, 20/20 (100%) right superior (RSPV) and inferior (RIPV) PVs, 18/19 (95%) left superior (LSPV) and inferior (LIPV) PVs, and 1/1 (100%) left common ostium (LCPV) were successfully isolated. First-pass success rate was 95%, 85%, 68%, and 95% for the RSPV, RIPV, LSPV, and LIPV, respectively. Touch-up radiofrequency ablation was required in 1/19 (5%) LSPV and LIPV. In group B, an attempt at circumferential PVI was feasible in 2/18 (11%) septal PVs and successful on first pass. Lateral circumferential PVI was attempted and successful on first-pass in 7/13 (54%) LSPVs and LIPVs and 1/5 (20%) LCPVs.


CONCLUSIONS
Using the EAS in patients with AF, separate isolation of individual PVs rather than wide circumferential PVI should be the preferred ablation strategy.
Department of Cardiology, Asklepios-Klinik St. Georg, Hamburg, Germany.
Erik
E
Wissner
Andreas
A
Metzner
Bruno
B
Reissmann
Peter
P
Rausch
Aleksander
A
Bardyszewski
Christine
C
Lemes
Roland Richard
RR
Tilz
Andreas
A
Rillig
Shibu
S
Mathew
Sebastian
S
Deiss
Feifan
F
Ouyang
Karl-Heinz
KH
Kuck
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
atrial fibrillation; catheter ablation; endoscopic ablation system; laser balloon; pulmonary vein isolation