Author(s)

Francesco Laurenzi, Piergiuseppe De Girolamo, Augusto Pappalardo, Andrea Avella

Department of Cardiology, Cardiac Arrhythmia Center, St. Camillo-Forlanini Hospital, Rome, Italy.

Purpose: Pulmonary vein isolation (PVI) is the accepted primary endpoint for catheter ablation of atrial fibrillation (AF). The aim of this study was to evaluate the level of PVI by PVAC, a multipolar circular catheter utilizing bipolar/unipolar radiofrequency (RF) energy. Methods: Twenty patients with paroxysmal AF underwent PVAC ablation. PVI was validated by voltage reduction and pacing tests. Before and after RF ablation, left atrium (LA) and PV electroanatomic mapping (EAM) were performed by EnSite NavX system. Voltage abatement was considered for potentials < 0.5 mV. RF lesion setting was compared to the PVs anatomy previously acquired by a cardiac CT scan. Results: Seventeen patients had four veins and three had a left common PV. All 77 PVs were isolated by PVAC. After RF, EAM showed low voltages areas at the proximal PV ostium and LA. Segmental voltage abatement slightly distal to the anatomic PV ostia was achieved in 20/77 (26%) PVs, more frequently in veins > 24mm: 9/20 (45%) vs 11/57 (19%), p < 0.05. Antral lesions were evident in 38/77 PVs (49%), limited to a part of the antrum in 29/38 (76%) veins, with larger occurrence in round than in oval PVs ostia: 25/36 (69%) vs 13/41 (32%), p < 0.001. Conclusions: Electrophysiological PVI with PVAC is achieved in all the veins with low voltages areas at the proximal PV ostium. A low voltage circumferential lesion at the anatomic PV ostia is more challenging in larger veins. Antral lesions, frequently affecting part of the antra, were more frequent in round PV ostia.

Atrial Fibrillation; Pulmonary Vein Isolation; Multipolar Circular Ablation Catheter; Electroanatomic Mapping

Laurenzi, F. , De Girolamo, P. , Pappalardo, A. and Avella, A. (2013) Left atrial voltage remodeling after pulmonary venous isolation with multipolar radiofrequency ablation. World Journal of Cardiovascular Diseases, 3, 493-498. doi: 10.4236/wjcd.2013.38078.