Duty-cycled multi-electrode radiofrequency vs. conventional irrigated point-by-point radiofrequency ablation for recurrent atrial fibrillation: comparative 3-year data.
OBJECTIVE
Pulmonary vein isolation (PVI) is an accepted treatment to relieve symptoms in patients with atrial fibrillation (AF). We studied 3 year outcome after PVI guided by duty-cycled multi-electrode radiofrequency (RF) ablation (pulmonary vein ablation catheter, PVAC) and provided comparative data to outcome after conventional PVI (CPVI) using mapping with irrigated, point-per-point RF ablation.


RESULTS
One hundred and sixty-one consecutive patients with symptomatic paroxysmal or persistent AF and minimal heart disease underwent PVI (PVAC, n = 79 vs. CPVI, n = 82). Follow-up (with symptom-guided rhythm monitoring) was truncated at 3 years in all patients. Success was defined as freedom of documented arrhythmia after a single procedure and without antiarrhythmic drug treatment (ADT). Baseline characteristics did not differ between both groups. At 3 years follow-up, single-procedure success without ADT was comparable between PVAC and CPVI (65% vs. 55%, P = NS). The majority of recurrences occurred during the first year (PVAC 79% vs. CPVI 70%, P = NS). The annual rate of very late recurrence (i.e. beyond 1 year) was similar in both groups (10.5% vs. 15%, P = NS).


CONCLUSIONS
At 3 years follow-up, outcome after PVAC-guided PVI is comparable to conventional isolation by irrigated point-by-point RF ablation. In both strategies, the majority of recurrences occurred in the first year of ablation.
Department of Cardiology, Antwerp Cardiovascular Institute Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium yves.degreef@zna.be.
Y
Y
De Greef
Department of Cardiology, Antwerp Cardiovascular Institute Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium.
I
I
Buysschaert
Department of Cardiology, Antwerp Cardiovascular Institute Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium.
B
B
Schwagten
Department of Cardiology, Antwerp Cardiovascular Institute Middelheim, Lindendreef 1, 2020 Antwerpen, Belgium.
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D
Stockman
Department of Cardiology, Sint Jan Hospital Bruges, Belgium.
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R
Tavernier
Department of Cardiology, Sint Jan Hospital Bruges, Belgium Department of Cardiology, University Hospital of Ghent, Belgium.
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M
Duytschaever
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D018780:Body Surface Potential Mapping / Q000295:instrumentation / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D007507:Therapeutic Irrigation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
Atrial fibrillation; Electro-anatomical mapping system; Pulmonary vein ablation catheter; Pulmonary vein isolation