Experience of atrial fibrillation ablation in a new cardiac centre using three-dimensional mapping and multielectrode duty-cycled radiofrequency ablation

Abstract

Catheter ablation is widely used to treat symptomatic atrial fibrillation (AF) refractory to drug therapy; and can be facilitated by a number of different techniques. To evaluate our performance as a new centre for AF ablation and to evaluate the efficacy of different AF ablation techniques. We employed three techniques in AF ablations; the three-dimensional (3D) mapping approaches (CARTO or Ensite NavX) or multielectrode catheter duty-cycled radiofrequency ablation (pulmonary vein ablation catheter [PVAC]). The immediate restoration of sinus rhythm was considered as acute success; while success at 6 months was determined by the maintenance of sinus rhythm on Holter monitoring. Between March 2008 and March 2010, 109 patients underwent AF ablations (mean age: 58 years; 72% male). Six-month success rates did not differ significantly between CARTO and NavX (40% vs 38%; P=0.81), but the PVAC group achieved greater success than the two 3D-mapping groups combined (68% vs 39%; P=0.004). Paroxysmal AF patients demonstrated greater 6-month success than persistent AF patients (P=0.005); and although the ratio of paroxysmal to persistent AF patients was slightly higher among the PVAC group, logistic regression confirmed PVAC and paroxysmal AF as predictors of success. Single-procedure success at 6 months was 48%. Including redo-ablations, some performed beyond the study period, our overall success rate at 6 months was 65%. Four patients experienced complications, but there were no deaths. Despite being a new centre with relative inexperience, we achieved success rates comparable to those of established tertiary centres. PVAC performed significantly better than the two 3D-mapping approaches.