Point-by-point pulmonary vein antrum isolation guided by intracardiac echocardiography and 3D mapping and duty-cycled multipolar AF ablation: effect of multipolar ablation on procedure duration and fluoroscopy time

Abstract

Pulmonary vein antrum isolation (PVAI) guided by intracardiac echocardiography and a roaming circular mapping catheter is an effective treatment modality for atrial fibrillation. Unfortunately, the complexity of this technique leads to long procedure times and high fluoroscopy exposure. Single-catheter multipolar ablation holds the promise to reduce these parameters. This study examined the effect of the conventional point-by-point PVAI with that of single-catheter multipolar ablation on the procedural characteristics and clinical outcomes of atrial fibrillation ablation. Referred patients underwent PVAI guided by a magnetic-based 3D mapping (CARTO 3(®) System; group 1) or duty-cycled multipolar AF ablation using the pulmonary vein ablation catheter (PVAC, group 2) between June 2010 and May 2011. Data were analyzed from 19 patients in group 1 and 31 patients in group 2. There was no significant difference in the length of the procedure between the two groups (135 ± 26 vs 125 ± 25 min, P = 0.20). Patients who underwent ablation using PVAC spent significantly less time in the procedure room pre- and post-procedure than those who underwent conventional PVAI (205 ± 38 vs 179 ± 30 min, P = 0.02) and had a significantly shorter fluoroscopy exposure (50 ± 16 vs 36 ± 14 min, P = 0.003) and radiofrequency energy delivery time (54 ± 26 vs 32 ± 33 min, P = 0.02). No differences in safety and efficacy were seen between the groups. Single-catheter multipolar AF ablation was associated with significantly lower fluoroscopy duration, radiofrequency energy delivery time, and the time the patient spent in the procedure room before and after ablation, although measured short-term clinical outcomes were similar.