270 Short-term results of pulmonary vein isolation for paroxysmal atrial fibrillation using duty-cycled bipolar and unipolar radiofrequency energy: The initial Québec experience

Abstract

BackgroundElectrical isolation of pulmonary veins (PV) is key to long term success of paroxysmal atrial fibrillation (AF) ablation. PV antral isolation using a conventional irrigated-tip catheter is often technically challenging and time consuming.MethodsTwenty-nine patients (mean age 55+/−13 years, 69% males) with symptomatic paroxysmal AF refractory to antiarrhythmic drugs underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of PVs with a power-modulated bipolar/unipolar radiofrequency (RF) generator using 8W delivered simultaneously through 2-10 electrodes, as selected by the operator. All ablations were performed under general anesthesia.ResultsMean left ventricular ejection fraction was 60+/−4% and mean left atrial volume was 27+/−5 ml/m2. Overall, 114 of 116 targeted PVs (98%) were isolated with the PVAC system with a mean of 32+/−8 RF applications per patient (total RF time 1921+/−493 seconds): 9+/−3 in the right superior PV, 7+/−3 in the right inferior PV, 9+/−4 in the left superior PV, and 7+/−3 in the left inferior PV. The mean procedure and fluoroscopy times were 171+/−35 min and 34+/−12 min respectively. The mean activated clotting time was 335+/−27 sec. After a mean follow-up of 3.6+/−1.7 months, 21 patients (72%) were free of AF without antiarrhythmic drugs . No procedure-related complications were observed.ConclusionPV isolation can be performed effectively, timely and safely using a circular decapolar ablation catheter. Long term and randomized data are needed to compare all different tools and ablation strategies for AF. BackgroundElectrical isolation of pulmonary veins (PV) is key to long term success of paroxysmal atrial fibrillation (AF) ablation. PV antral isolation using a conventional irrigated-tip catheter is often technically challenging and time consuming. Electrical isolation of pulmonary veins (PV) is key to long term success of paroxysmal atrial fibrillation (AF) ablation. PV antral isolation using a conventional irrigated-tip catheter is often technically challenging and time consuming. MethodsTwenty-nine patients (mean age 55+/−13 years, 69% males) with symptomatic paroxysmal AF refractory to antiarrhythmic drugs underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of PVs with a power-modulated bipolar/unipolar radiofrequency (RF) generator using 8W delivered simultaneously through 2-10 electrodes, as selected by the operator. All ablations were performed under general anesthesia. Twenty-nine patients (mean age 55+/−13 years, 69% males) with symptomatic paroxysmal AF refractory to antiarrhythmic drugs underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of PVs with a power-modulated bipolar/unipolar radiofrequency (RF) generator using 8W delivered simultaneously through 2-10 electrodes, as selected by the operator. All ablations were performed under general anesthesia. ResultsMean left ventricular ejection fraction was 60+/−4% and mean left atrial volume was 27+/−5 ml/m2. Overall, 114 of 116 targeted PVs (98%) were isolated with the PVAC system with a mean of 32+/−8 RF applications per patient (total RF time 1921+/−493 seconds): 9+/−3 in the right superior PV, 7+/−3 in the right inferior PV, 9+/−4 in the left superior PV, and 7+/−3 in the left inferior PV. The mean procedure and fluoroscopy times were 171+/−35 min and 34+/−12 min respectively. The mean activated clotting time was 335+/−27 sec. After a mean follow-up of 3.6+/−1.7 months, 21 patients (72%) were free of AF without antiarrhythmic drugs . No procedure-related complications were observed. Mean left ventricular ejection fraction was 60+/−4% and mean left atrial volume was 27+/−5 ml/m2. Overall, 114 of 116 targeted PVs (98%) were isolated with the PVAC system with a mean of 32+/−8 RF applications per patient (total RF time 1921+/−493 seconds): 9+/−3 in the right superior PV, 7+/−3 in the right inferior PV, 9+/−4 in the left superior PV, and 7+/−3 in the left inferior PV. The mean procedure and fluoroscopy times were 171+/−35 min and 34+/−12 min respectively. The mean activated clotting time was 335+/−27 sec. After a mean follow-up of 3.6+/−1.7 months, 21 patients (72%) were free of AF without antiarrhythmic drugs . No procedure-related complications were observed. ConclusionPV isolation can be performed effectively, timely and safely using a circular decapolar ablation catheter. Long term and randomized data are needed to compare all different tools and ablation strategies for AF. PV isolation can be performed effectively, timely and safely using a circular decapolar ablation catheter. Long term and randomized data are needed to compare all different tools and ablation strategies for AF.