Abstract 2852: Pulmonary Vein Isolation With a Single Catheter Approach: Safety and Efficacy
Background: Pulmonary Vein (PV) isolation remains a cornerstone for ablation of atrial fibrillation (AF). Due to the increasing demand of ablation procedures, technical advances to reduce procedure time and improve the safety profile of PV isolation would be beneficial. We investigated the efficiency, as well as medium-term safety and efficacy of a decapolar ablation catheter combined with a multi-channel, duty-cycled radiofrequency (RF) generator for PV isolation. This technique does not require 3D mapping and allows mapping, pacing and ablation with a single catheter.
Methods: AF ablation was performed in 45 consecutive patients with paroxysmal AF (mean age 58±14 years, 20 males) using the Pulmonary Vein Ablation Catheter (PVAC). CT or MR imagining of the left atrium (LA) and the PVs was performed in all patients to reveal anomalous anatomical configurations that may affect ablation technique. The PVAC was introduced into the LA via single transseptal puncture, and optimal catheter position was achieved using a steerable sheath and over-the-wire technique. RF energy was typically delivered for 60s with a 60-degree target temperature using all 10 electrodes. If necessary, segmental ablations using selected electrodes were delivered until isolation was achieved. Acute success was defined by elimination of PV signals, verified by differential pacing from the coronary sinus and LA appendage. Freedom from AF was defined as no episodes of AF >30sec measured by 72-hour Holter monitor at 6 months follow up. PV stenosis was defined as narrowing greater than 30%.
Results: Isolation of PVs was achieved using only PVAC in all but one vein. Total median RF application time was 24±8 min. Procedure time was 78±16 min after transseptal access; fluoroscopy time was 29±13 min. There were no procedural complications. At 6 months follow-up, comparative MR/CT imagining showed no significant difference in vein diameter and no patients had asymptomatic PV stenosis. 86% (39/45) of patients were free from AF.
Conclusion: Isolation of PV can be performed in a safe and efficient technique using the PVAC and multi-channel RF generator. There is no need for complex 3D mapping or navigation equipment, and the short procedure times allow for treatment of more patients.