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J Am Coll Cardiol, 2002; 40:464-474
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY

Circular mapping and ablation of thepulmonary vein for treatment of atrial fibrillation

Impact of different catheter technologies

Nassir F. Marrouche, MD*, Thomas Dresing, MD*, Christopher Cole, MD*, Dianna Bash, RN*, Eduardo Saad, MD*, Krzysztof Balaban, MD*, Stephen V. Pavia, MD*, Robert Schweikert, MDFACC*, Walid Saliba, MDFACC*, Ahmed Abdul-Karim, MD*, Ennio Pisano, MD{dagger}, Raffaele Fanelli, MD{dagger}, Patrick Tchou, MDFACC* and Andrea Natale, MD*,*

* Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
{dagger} Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

Manuscript received June 7, 2001; revised manuscript received April 2, 2002, accepted April 30, 2002.

* Reprint requests and correspondence: Dr. Andrea Natale, Co-Head Section of Pacing and Electrophysiology, Director Electrophysiology Laboratory, Department of Cardiology, Cleveland Clinic Foundation, Desk F 15, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
natalea{at}ccf.org

OBJECTIVES: We conducted this study to compare the efficacy and safety of different catheter ablation technologies and of distal versus ostial pulmonary veins (PV) isolation using the circular mapping technique.

BACKGROUND: Electrical isolation of the PVs in patients with atrial fibrillation (AF) remains a technical challenge.

METHODS: Two hundred eleven patients (163 men; mean age 53 ± 11 years) with symptomatic AF were included in this study. In the first 21 patients (group 1), distal isolation (≥5 mm from the ostium) was achieved targeting veins triggering AF. In the remaining 190 patients (group 2), ostial isolation of all PVs was performed using 4-mm tip (47 patients), 8-mm tip (21 patients), or cooled-tip (122 patients) ablation catheters.

RESULTS: Distal isolation was able to eliminate premature atrial contractions (PACs) and AF in six of 21 patients (29%) and 10 of 34 PVs. After a mean follow-up time of 6 ± 4 months, no patients treated with the 8-mm tip catheter experienced recurrence of AF, whereas 21% (10 of 47 patients) and 15% (18 of 122 patients) of the patients ablated with the 4-mm tip and the cooled-tip ablation catheters experienced recurrence of AF after a mean follow-up of 10 ± 3 and 4 ± 2 months, respectively. Significant complications including stroke, tamponade, and severe stenosis occurred in 3.5% (8/211) of patients.

CONCLUSIONS: Catheter technologies designed to achieve better lesion size appeared to have a positive impact on procedure time, fluoroscopy time, number of lesions, and overall efficacy. Although distal isolation can be achieved with fewer lesions, ostial isolation is required in the majority of patients to eliminate arrhythmogenic PACs and AF.

Abbreviations and Acronyms
  AF
  atrial fibrillation
  LA
  left atrium
  LLPV
  left lower pulmonary vein
  LUPV
  left upper pulmonary vein
  PAC
  premature atrial contractions
  PV
  pulmonary vein
  PVP
  pulmonary vein potential
  RLPV
  right lower pulmonary vein
  RUPV
  right upper pulmonary vein




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