Single-catheter technique for pulmonary vein antrum isolation: is it sufficient to identify and close the residual gaps without a circular mapping catheter?

OBJECTIVES: The present study was designed to investigate the feasibility and efficacy of single ablation catheter for complete circumferential pulmonary vein antrum (PVA) isolation.

BACKGROUND: Complete isolation of pulmonary veins is the mainstay for atrial fibrillation (AF) ablation. This is usually performed under the guidance of a circular catheter.

METHODS: One hundred and ten consecutive patients with paroxysmal AF were prospectively randomized into two groups: single-catheter approach (group 1) and double-catheter approach (group 2). After performing initial circumferential lesions, residual gaps were mapped and closed with single ablation catheter in group 1 or guided by a circular mapping catheter in group 2 using an electroanatomic mapping system (CARTO XP, Biosense-Webster Inc., Diamond Bar, CA, USA).

RESULTS: Complete bilateral PVA isolation was achieved in 22 of the 110 patients after initial ablation. All residual gaps could be correctly identified by activation mapping using single ablation catheter. The distribution of these residual gaps was asymmetric. In group 1, 25 gaps along the right PVA lesions and 49 gaps along the left PVA lesions were identified. All the residual gaps were closed with single-catheter approach. In group 2, 28 gaps on the right side and 53 gaps on the left side were identified using a circular catheter and closed with further ablations. The procedure data and clinical outcomes between the two groups were comparable.

CONCLUSIONS: Single ablation catheter technique is feasible and as effective as circular catheter mapping in localizing the residual gaps for PVA isolation during ablation of paroxysmal AF.