title: Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation.
abstract: BACKGROUND
  Pulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation.
  
  
  METHODS
  50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLDTM, Medtronic Inc.) ablation. The Gold-MEA catheter was navigated to the PV ostium by fluoroscopy. Duty-cycled radiofrequency ablations were performed at all PV ostia. Lesions were considered transmural when electrode temperature was >50 °C and power >3 W for >30 seconds. After the ablation procedure, patients visited the outpatient clinic at 3‑month intervals including 24-hour Holter ECGs.
  
  
  RESULTS
  Mean age was 56 years. All PVs were acutely isolated with the Gold-MEA catheter. Procedure time was 111 ± 22 minutes, ablation time was 24 ± 6.7 minutes and fluoroscopy time was 20 ± 8.1 minutes. No procedure-related complications were observed. One year after ablation, 60 % of patients were still free of arrhythmia recurrences after a single PV isolation attempt. The number of transmural lesions was associated with arrhythmia-free survival: 25.0 % in <72 transmural lesions, 64.3 % in 72-108 transmural lesions and 71.4 % in >108 transmural lesions (p = 0.029).
  
  
  CONCLUSIONS
  PV isolation can be performed successfully with the Gold-MEA catheter, with a favourable safety profile. Transmurality of lesions was associated with ablation success and may improve AF ablation success.
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Gal
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: T J
authors.initials: TJ
authors.lastname: Buist
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: J J J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
authors.forename: P P H M
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands. v.r.c.derks@isala.nl.
authors.forename: A
authors.initials: A
authors.lastname: Elvan
keywords: Ablation; Atrial fibrillation; Effective energy; Multi-electrode ablation; PVAC Gold