Submit Manuscript    >>    Login | Register

High Voltage Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Background: Ablation of the pulmonary vein (PV) antrum using an electroanatomic mapping system is standard of care for point-by-point pulmonary vein isolation (PVI). Focused ablation at critical areas is more likely to achieve intra-procedural PV isolation and decrease the likelihood for reconnection and recurrence of atrial fibrillation (AF). Therefore this prospective pilot study is to investigate the short-term outcome of a voltage-guided circumferential PV ablation (CPVA) strategy. Methods: We recruited patients with a history paroxysmal atrial fibrillation (AF). The EnSite NavX system (St. Jude Medical, St Paul, Minnesota, USA) was employed to construct a three-dimensional geometry of the left atrium (LA) and voltage map. CPVA was performed; with radiofrequency (RF) targeting sites of highest voltage first in a sequential clockwise fashion then followed by complete the gaps in circumferential ablation. Acute and short-term outcomes were compared to a control group undergoing conventional standard CPVA using the same 3D system. Follow-up was scheduled at 3, 6 and 12 months. Results: Forty-three patients with paroxysmal AF were included. Fourteen patients (8 male) underwent voltage mapping and 20 patients underwent empirical, non-voltage guided standard CPVA. A mean of 54 12 points per PV antrum were recorded. Mean voltage for right and left PVs antra were 1.70.1 mV and 1.90.2 mV, respectively. There was a trend towards reduced radiofrequency time (40.917.4 vs. 48.115.5 mins; p=0.22), fluoroscopy time (29.20.4 vs. 33.617.7 mins; p= 0.36) and procedure time (233.836.1 vs. 248.8 53.6 mins; p= 0.32) in the voltage guided RF group vs standard CPVA respectively. Mean follow-up of 46.4 13.7 weeks showed recurrence of AF and/or atrial tachycardia was identified in 3/13 (23 %) in the voltage-guided group vs. 7/18 (39 %) in the control group (p= 0.2). Conclusion: Voltage-guided CPVA is a promising strategy in targeting critical points for PV isolation with a lower trend of AF recurrence compared with a standard CPVA in short-term period. Extended studies to confirm these findings are warranted.

Credits: Usama Boles, Enes E Gul, Andres Enriquez, Howard Lee, Dave Riegert, Adrian Andres, Adrian Baranchuk, Damian Redfearn, Benedict Glover, Chris Simpson, Hoshiar Abdollah, Kevin Michael

Biosense Webster
event date
Introduction to AFib
Ablation Specialist

View Ablation Specialists