Multielectrode phased radiofrequency ablation compared with point-by-point ablation for pulmonary vein isolation – outcomes in 539 patients

Abstract

Purpose: To provide data on acute and long-term outcomes from pulmonary vein isolation with the pulmonary vein ablation catheter (PVAC) in patients with paroxysmal or persistent atrial fibrillation (AF). Methods:This was a single-center, retrospective, nonrandomized, case control study. Patients with documented symptomatic paroxysmal or persistent AF were treated with PVAC or with pointby-point radiofrequency ablation guided by the NavX™ mapping system. All follow-up visits were conducted in our center at 1 month, 3 months, and 6 months, and then at 6-month intervals. Electrocardiography and 24-hour Holter monitoring were performed at each follow-up visit. The endpoints included procedure times, acute and 24-month outcomes, and complications. Results: Of the 539 patients that were enrolled consecutively, 388 were ablated using PVAC and 151 using radiofrequency ablation. More patients with paroxysmal AF were treated with PVAC than with radiofrequency ablation. Acute success rates were .99% with both methods. Procedure duration and fluoroscopy times were significantly (P,0.001) shorter with PVAC than with point-by-point ablation. Rates of freedom from AF at all follow-up times available (up to 24 months) were significantly higher after PVAC ablation than with radiofrequency ablation (64.2% versus 48.2% at 24 months). With both ablation strategies, the rates of freedom from AF were higher in patients with paroxysmal AF than for persistent AF. Two posterior cerebral infarcts occurred in the PVAC group within 2 days of the procedure. No phrenic nerve injuries and no esophageal injuries were recorded. Data on embolic lesions were not collected. Conclusion: PVAC ablation achieved higher 24-month rates of AF-free survival than conventional radiofrequency ablation. Procedure and fluoroscopy times were shorter with PVAC, although the differences between groups may have influenced the results.

Theoretical and experimental analysis of amplitude control ablation and bipolar ablation in creating linear lesion and discrete lesions for treating atrial fibrillation

“…Recently, the multipolar RF ablation technology has recently been clinically investigated for treating AF. Spitzer et al conducted several clinical studies in which they compared the success rate and effectiveness of point-to-point ablation and multipolar phase RF ablation in 539 patients [5]. Basu et al reported that the bipolar ablation for AF was substantially shorter of procedure time and a greater guarantee of transmural lesions compared with the unipolar ablation [6].…”

A simulation study to compare the phase-shift angle radiofrequency ablation mode with bipolar and unipolar modes in creating linear lesions for atrial fibrillation ablation

“…The phase-shift angle RF ablation technique has recently been clinically investigated for treating AF, and the first related clinical result for PVI was published by Wieczorek et al [1]; they reported that the phase-shift angle RF energy used in the PVI procedure was safer and that the procedure was substantially shorter compared with the conventional procedure [2]. Spitzer et al [3] conducted several clinical studies in which they compared the success rate and effectiveness of point-to-point ablation and multi-electrode phase RF ablation in 539 patients. Bulava et al [4] performed a rando-mised comparison between phase-shift angle RF ablation and point-to-point ablation for AF and reported similar clinical success rates for both procedures.…”

Catheter Ablation of Atrial Fibrillation: A Review of the Current Status and Future Directions

“…[77][78][79][80][81][82][83][84][85][86][87][88][89][90][91] There is some, though limited, data available on the achievement of improved procedural success rates using multielectrode ablation in comparison with using single-electrode irrigated ablation. 92,93 Importantly, despite the early mixed success rates for these emerging technologies, these studies typically represented first-or early-generation devices that had likely not reached full maturity or efficacy. The goal of performing longer or larger contiguous lesions with a single ablation procedure remains attractive, especially for its potential to improve procedural efficiency.…”