CLINICAL RESEARCH: HEART RHYTHM DISORDER
Ablation of Persistent Atrial Fibrillation Using Multielectrode Catheters and Duty-Cycled Radiofrequency Energy
Christoph Scharf, MD*,*,
Lucas Boersma, MD ,
Wyn Davies, MD ,
Prapa Kanagaratnam, PhD,
Nicholas S. Peters, MD,
Vince Paul, MD ,
Edward Rowland, MD,
Andrew Grace, MD||,
Simon Fynn, MD||,
Lam Dang, PhD*,
Hakan Oral, MD¶ and
Fred Morady, MD¶
* Cardiovascular Center, Clinic im Park, Zurich, Switzerland
St. Antonius Hospital, Nieuwegein, the Netherlands
St. Mary's Hospital, Imperial College, London, United Kingdom
St. George's Hospital, London, United Kingdom
|| Papworth Hospital, Cambridge, United Kingdom
¶ University of Michigan, Ann Arbor, Michigan
Manuscript received April 24, 2009;
revised manuscript received July 6, 2009,
accepted July 13, 2009.
* Reprint requests and correspondence: Dr. Christoph Scharf, Cardiovascular Center, Clinic Im Park, Seestrasse 220, 8027 Zurich, Switzerland (Email: christoph.scharf{at}gmail.com).
Objectives: The purpose of this study was to assess the efficacy and safety of a novel, multielectrode, duty-cycled radiofrequency ablation (RFA) system for long-standing persistent atrial fibrillation (AF).
Background: RFA for persistent AF remains a lengthy and challenging procedure.
Methods: In 5 European centers, 50 patients with long-standing persistent AF underwent RFA. A circular pulmonary vein (PV) ablation catheter was used for PV isolation. Complex fractionated atrial electrograms were targeted at the interatrial septum using a multiarray septal ablation catheter and in the left atrium using a multiarray ablation catheter.
Results: During a mean total procedure time of 155 ± 40 min, complete PV isolation and complex fractionated atrial electrogram ablation were achieved in all patients. In 50% of patients, redo ablation was performed using the same strategy and technology. There were no device-related adverse events. At 6 months, a 7-day Holter electrocardiogram showed >80% AF reduction in 40 of 50 patients (80%), and 32 of 50 (64%) were off antiarrhythmic drugs. At 20 ± 4 months after the last procedure, 31 of 47 patients (66%) had a >80% reduction in AF burden, with 21 patients (45%) free of AF and off antiarrhythmic drugs.
Conclusions: This initial 50-patient multicenter study demonstrates a 80% short-term and 66% success rate at 20 months, with a low complication rate and a relatively short procedure time in patients with persistent AF using 3 anatomically specific multielectrode ablation catheters and low-energy duty-cycled radiofrequency energy.
Key Words: atrial fibrillation • radiofrequency • ablation
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Abbreviations and Acronyms
| | ACT = activated clotting time | | AF = atrial fibrillation | | CFAE = complex fractionated atrial electrograms | | CT = computed tomography | | ECG = electrocardiogram | | MAAC = multiarray ablation catheter | | MASC = multiarray septal catheter | | MCS = mental component score | | MRI = magnetic resonance imaging | | PCS = physical component score | | PV = pulmonary vein | | PVAC = pulmonary vein ablation catheter | | RF = radiofrequency | | RFA = radiofrequency ablation |
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