Results of Short-Term and Long-Term Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Using Duty-Cycled Bipolar and Unipolar Radiofrequency Energy

Abstract

PV Isolation Using Bipolar/Unipolar RF Energy . Background: Electrical disconnection of the pulmonary veins (PV) plays an important role in the ablation of paroxysmal atrial fibrillation (AF). Antral ablation using a conventional steerable ablation catheter often is technically challenging and time consuming. Methods: Eighty-eight patients (mean age 58 ± 11 years) with symptomatic paroxysmal AF underwent ablation with a circular mapping/ablation decapolar catheter (PVAC). Ablation was performed in the antral region of the PVs with a power-modulated bipolar/unipolar radiofrequency (RF) generator using 8–10 W delivered simultaneously through 2–10 electrodes, as selected by the operator. Seven-day Holter monitor recordings were performed off antiarrhythmic drugs at 3-, 6-, and 12-month follow-up, and patients were requested to visit the hospital in the event of ongoing palpitations. All follow-up patients were divided into 2 groups: Group 1 with a follow-up of less than 1 year and group 2 patients completing a 1-year follow-up. Results: Overall, 338 of 339 targeted PVs (99%) were isolated with the PVAC with a mean of 24 ± 9 RF applications per patient, a mean total procedure time of 125 ± 28 minutes, and a mean fluoroscopy time of 21 ± 13 minutes. Freedom from AF off antiarrhythmic drugs was found in 82 and 79% of group 1 and group 2 patients, respectively. No procedure-related complications were observed. Conclusion: PV isolation by duty-cycled unipolar/bipolar RF ablation can be effectively and safely performed with a circular, decapolar catheter. Twelve-month follow-up data compare favorably with early postablation results, indicating stable effects over time. (J Cardiovasc Electrophysiol, Vol. 21, pp. 399–405, April 2010)