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(Circulation. 2003;108:2484.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Feasibility and Safety of Pulmonary Vein Isolation Using a New Mapping and Navigation System in Patients With Refractory Atrial Fibrillation

Thomas Arentz, MD; Jörg von Rosenthal, MD; Thomas Blum, MD; Jochem Stockinger, MD; Gerd Bürkle, MD; Reinhold Weber, MD; Nikolaus Jander, MD; Franz Josef Neumann, MD; Dietrich Kalusche, MD

From Rhythmologie, Herz-Zentrum, Bad Krozingen, Germany.

Correspondence to Thomas Arentz, MD, Herz-Zentrum, Abteilung Rhythmologie, Südring 15, 79188 Bad Krozingen, Germany. E-mail thomas.arentz{at}herzzentrum.de

Received February 27, 2003; de novo received June 4, 2003; revision received August 14, 2003; accepted August 17, 2003.

Background— Ostial pulmonary vein (PV) isolation by radiofrequency (RF) catheter ablation can cure patients with atrial fibrillation (AF); however, this procedure carries the risk of PV stenosis. The aim of this study was to assess the feasibility of a new mapping and navigation technique using a multipolar basket catheter (BC) for PV isolation in patients with refractory AF and to analyze its safety with regard to PV stenosis at long-term follow-up.

Methods and Results— We studied 55 patients (mean age, 53±11 years; 40 male) with drug-refractory AF (paroxysmal, n=37; persistent, n=18). A 64-pole BC was placed transseptally into each of the accessible PVs. By use of a nonfluoroscopic navigation system, the ablation catheter was guided to the BC electrodes at the PV ostium, with earliest activation during sinus rhythm. RF was delivered by use of maximum settings of temperature at 50°C and power at 30 W. The end point of the procedure was the complete elimination of all distal and fragmented ostial PV potentials. Of 165 targeted veins, 163 were successfully isolated with a mean RF duration of 720±301 seconds per vein. At 1-year follow-up, 62% of the patients were in sinus rhythm without antiarrhythmic drugs. Contrast-enhanced magnetic resonance angiography revealed 2 PV stenoses of >25% out of 165 treated vessels.

Conclusions— The use of a multipolar BC allowed effective and safe PV isolation by combining 3D mapping and navigation. At 1-year follow-up, 62% of the patients were in sinus rhythm without antiarrhythmic drugs, and the incidence of relevant diameter reduction of the treated PVs was 1.2%.

Key Words: fibrillation • ablation • lung • veins • imaging

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