Mapping and Isolation of the Pulmonary Veins Using the PVAC Catheter

Abstract

(1) PVAC-guided ablation (i.e., mapping and ablation with a single catheter) results in isolation of all PVs in 73% of the patients. (2) An additional circular mapping catheter is required to increase complete isolation rate to 93% of the patients. (3) Given the esophageal T degrees rise in almost 50% of patients, safety precautions are needed.

Efficacy of multi-electrode duty-cycled radiofrequency ablation in patients with paroxysmal and persistent atrial fibrillation

“…This is also observed with the HDMA catheter and the cryoballoon [9,10]. However, in case of a common ostium or when early branching is present, the guidewire can be positioned in different side branches of the PV resulting in different PVAC positions, creating overlapping ablation lines that as a whole result in a more wide circumferential PVI [8].…”

“…Mansour et al [5] presented that 12% of the veins which seemed isolated on the HDMA, were not isolated on a regular circular mapping catheter. The other study showed that PVAC has a diagnostic accuracy of 95% [8]. Authors suggested that bipolar electrograms are less detailed (most likely due to larger electrode size) but allowed to correctly diagnose PVPs.…”

“…The PVAC procedure has been launched in our center in November 2009 so there is no data available for such a long follow-up. However, in comparison to other available publications on PVAC, our median follow-up period of 16 months is a big achievement [7,8,11,13]. There is information about late recurrences which are defined as a recurrence of AF 12 months or more after ablation (Episodes of atrial tachycardia or atrial flutter should also be classified as a "recurrence".)…”

“…In these patients PVI assessment was based only upon PVAC recordings and reported to be 100%. Other authors suggest using steerable sheath, enhanced fluoroscopy, different guidewire positions in different side branches of the PVs, and registration of ostial potentials to obtain high isolation rates with the PVAC [8]. They also hypothesize that the use of the PVAC catheter by its design results in general in an ostial ablation.…”

“…Authors suggested that bipolar electrograms are less detailed (most likely due to larger electrode size) but allowed to correctly diagnose PVPs. To obtain high diagnostic accuracy with the PVAC catheter authors advocate: to torque the PVAC catheter within the PVs, to annotate baseline PVPs at fixed fluoroscopic references before any RF delivery, and to apply limited pacing maneuvers [8]. In our procedures we were mapping according to those tips.…”