Premium
Initial Experience with the High‐Density Mesh Ablation Catheter for Pulmonary Vein Isolation
Author(s) -
DE GREEF YVES,
STOCKMAN DIRK,
DUYTSCHAEVER MATTIAS,
VANDEKERCKHOVE YVES,
TAVERNIER RENE
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02494.x
Subject(s) - medicine , pulmonary vein , atrial fibrillation , ablation , catheter , fluoroscopy , catheter ablation , surgery , biomedical engineering , cardiology
Background: Pulmonary vein isolation (PVI) is usually performed with multiple point‐by‐point radiofrequency ablation with a second multielectrode circular mapping catheter to validate isolation. We evaluated a 30‐mm high‐density mesh electrode (HDMA) for mapping and PVI in patients with recurrent atrial fibrillation (AF).Methods: In 13 patients (validation group) up to three pulmonary veins (PVs) were targeted with the HDMA. A circular mapping catheter was used to validate PVI. PVI was completed with a CARTO‐guided approach (Biosense Webster, Diamond Bar, CA, USA) followed by a voltage remap. In 11 patients (feasibility group) the HDMA catheter was evaluated as a stand‐alone mapping and ablation tool.Results: The diagnostic accuracy of the HDMA catheter to evaluate PVI was 100%. The encircled low‐voltage area (<0.15 mV) after HDMA‐guided PVI was smaller compared to CARTO‐guided PVI. In the feasibility group 76% of the PVs could be isolated. Complete isolation of all PVs was feasible in five patients (45%) with a mean procedure and fluoroscopy time of respectively 180 ± 39 minutes and 40 ± 14 minutes. After 1 year 64% of the patients were free of symptomatic AF.Conclusions: The HDMA electrode is a reliable mapping tool to validate PVI. The majority of PVs can be isolated, but on a patient basis touch‐up ablations are necessary in more than 50% of the cases. Therefore, modifications in catheter design are required. The small area of voltage abatement points to an ostial left atrium‐pulmonary vein disconnection. Initial clinical results in a small number of patients are promising.