ELECTROPHYSIOLOGY
The effectiveness of a high output/short duration radiofrequency current application technique in segmental pulmonary vein isolation for atrial fibrillation
Medical Department B, Department of Cardiology, The Heart Centre, Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark
Aims Segmental pulmonary vein (PV) isolation by radiofrequency (RF) catheter ablation has become a curative therapy for atrial fibrillation (AF). However, the long procedure time limits the wide application of this procedure. The aim of the current study was to compare a novel ablation technique with a high power output and short application time vs. a conventional technique using a low power output and long application time.
Methods and results The study included 90 consecutive patients (age 53±10 years; 66 men). Segmental PV isolation was performed by irrigated RF catheter ablation in both groups. In the conventional group (Group 1, 45 patients), the power output was limited to 30 W with a target temperature of 50°C and an RF preset duration of 120 s. In the novel group (Group 2, 45 patients), the maximum power output was preset to 45 W, with a target temperature of 55°C and duration of 20 s. In Group 2, a significant reduction in the PV isolation time (127±57 vs. 94±33 min, P<0.02), mean fluoroscopy time (73±23 vs. 55±16 min, P<0.001), and radiation dose was observed. According to the application time and number, Group 2 showed a reduction in RF application time, but a higher number of RF applications were required for creation of complete PV isolation. During a mean follow-up of 15±7 months, a total of 74% of patients in Group 1 and 76% of patients in Group 2 demonstrated stable SR.
Conclusion Segmental PV isolation using a high power output and short application time is safe and effective in PV isolation in patients with AF. This technique can significantly reduce the procedure and fluoroscopy time compared with a low-power output technique.
Key Words: Atrial fibrillation, Catheter ablation, Pulmonary vein isolation
* Corresponding author. Tel: +45 3545 8449; fax: +45 3545 2705. E-mail address: brni{at}dadlnet.dk
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  T. Terasawa, E. M. Balk, M. Chung, A. C. Garlitski, A. A. Alsheikh-Ali, J. Lau, and S. Ip Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Ann Intern Med, August 4, 2009; 151(3): 191 - 202. [Abstract] [Full Text] [PDF]
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