title: Conventional radiofrequency catheter ablation compared to multi-electrode ablation for atrial fibrillation.
abstract: BACKGROUND
  Limited data is available on long-term atrial fibrillation (AF) free survival after multi-electrode catheter pulmonary vein isolation (PVI). The aim of this study was to compare point-by-point PVI to multi-electrode PVI in terms of procedural characteristics and long-term AF free survival.
  
  
  RESULTS
  460 consecutive patients were randomly allocated: 230 patients underwent conventional, point-by-point ablation with a radiofrequency ablation catheter (cPVI group) and 230 patients underwent multi-electrode, phased radiofrequency ablation (MER group). Median follow-up was 43 months. Mean age was 56 years, 82% of patients had paroxysmal AF. Baseline characteristics did not differ among catheter groups. Acute electrical PVI was achieved in 99.7% of pulmonary veins, with no differences among catheter groups. Procedure time and ablation time were significantly shorter in the MER group. There were significantly less complications in the MER group (4.8% vs. 1.3%, P=0.025). After a mean of 1.5 procedures, AF free survival without the use of antiarrhythmic drugs was 74% at 1 year and 46% at 5 years follow-up and did not differ among catheter groups (cPVI group 45%, MER group 48%, P=0.777). In multivariate analysis, BMI, AF duration and CHADSVASc score were predictors of AF free survival.
  
  
  CONCLUSIONS
  Multi-electrode ablation was superior in procedure duration and ablation time, with less complications. However, both conventional point-by-point PVI and multi-electrode PVI achieved a high acute PVI success rate and showed a comparable long-term AF free survival.
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Gal
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Alissa E S M
authors.initials: AE
authors.lastname: Aarntzen
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Jaap Jan J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Anand R Ramdat
authors.initials: AR
authors.lastname: Misier
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Peter Paul H M
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands. Electronic address: v.r.c.derks@isala.nl.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Atrial fibrillation; Long-term follow-up; Multi-electrode ablation; Point by point ablation; Pulmonary vein isolation; Radiofrequency catheter ablation