Clinical experience with routine use of a single combined mapping and ablation catheter for isolation of pulmonary veins in patients with paroxysmal atrial fibrillation.

BACKGROUND: Catheter-based isolation of pulmonary veins has become established treatment for patients with paroxysmal atrial fibrillation. We wished to simplify the interventional procedure by using a single novel multipolar catheter for mapping and ablation in appropriate patients.

METHODS: Sixty-four patients with paroxysmal atrial fibrillation scheduled for pulmonary vein isolation were screened by cardiac computed tomography for anatomic suitability to undergo a simplified procedure with the high-density mesh ablator catheter (MESH) as the only left atrial device. The procedure was undertaken in 38 patients matching the criteria of four clearly separated pulmonary veins with ostial diameters 15-25 mm; the remaining 26 patients served as a control group and were treated using a three-dimensional mapping system guided ablation using a circular mapping catheter and a single-point ablation catheter.

RESULTS: In all 38 patients, all four pulmonary veins could be accessed and mapped with the MESH. Using the MESH, electrical isolation was achieved in 142/148 (96%) pulmonary veins with recorded potentials. In the control group, 100/105 (95%) pulmonary veins with recorded potentials could be isolated. After 6 months, clinical results did not differ significantly between the two treatment groups.

CONCLUSION: In appropriate patients, the routine single catheter approach with the MESH for mapping and ablation yields a high acute success rate despite the reduced complexity of the procedure. Long-term data on clinical success rates are needed to justify this simplified approach.