Multielectrode phased radiofrequency ablation compared with point-by-point ablation for pulmonary vein isolation – outcomes in 539 patients

Figures & data

Figure 1 Pulmonary vein ablation catheter electrograms from the left inferior pulmonary vein.

Notes: (A) Conductance pattern before ablation; (B) entrance block demonstrated after successful ablation with pulmonary vein ablation catheter; (C) during stimulation before ablation; and (D) exit block demonstrated after successful ablation with pulmonary vein ablation catheter.
Abbreviations: CS, coronary sinus electrode; PVAC, pulmonary vein ablation catheter.

Table 1 Baseline characteristics

Variable	NavX-guided ablation (n=151)	PVAC ablation (n=388)	P-value
Age years ± SD	58.1±9.3	61.7±9.7	<0.0001
Male sex, n (%)	107 (70.8%)	249 (64.2%)	0.17
Hypertension, n (%)	73 (48.3%)	147 (37.9%)	0.03
LA size mm ± SD	43±5	42±6	0.02
LVEF % ± SD	53.4±7.2	59.5±8.1	0.54
Mean duration of AF years ± SD	1.79±3.5	2.23±3.2	<0.0001
Type of AF n (%)			<0.0001
Paroxysmal	82 (54.3%)	310 (79.9%)
Persistent	47 (31.1%)	68 (17.5%)
Long-lasting (>1 year) persistent	22 (14.6%)	10 (2.6%)
Coronary artery disease, n (%)	19 (12.6%)	48 (12.4%)	0.003
Cardiomyopathy, n (%)	6 (4.0%)	6 (1.5%)	0.1645
Mitral insufficiency, n (%)	88 (58.3%)	219 (73.6%)^Table Footnotea	<0.0001
Previous antiarrhythmic medication, n (%)	54 (35.8%)	198 (51.0%)
Flecainide	30 (19.9%)	83 (41.9%)
Propafenone	8 (5.3%)	23 (11.9%)
Amiodarone	14 (9.2%)	32 (22.3%)
Dronedarone	2 (1.3%)	59 (15.2%)
Verapamil	0	4 (1.0%)

Note:

a Data were missing for nine patients.

Abbreviations: n, number; PVAC, pulmonary vein ablation catheter; SD, standard deviation; LA, left atrium; AF, atrial fibrillation; LVEF, left ventricular ejection fraction.

Table 2 Procedural data

	NavX-guided ablation (n=151)	PVAC ablation (n=388)	P-value
Procedure time minute ± SD	142.2±35.0	67.0±18.0	<0.001
Fluoroscopy time minute ± SD	29.3±9.8	15.6±5.7	<0.001
Number of applications ± SD	53.7±22.6	17.5±4.5	<0.0001
Energy applied W/second ± SD	46.0±16.1	38.3±10.5	<0.001

Abbreviations: n, number; PVAC, pulmonary vein ablation catheter; SD, standard deviation.

Table 3 Univariate analysis of predictors of long-term freedom from ablation

Variable	Odds ratio	95% confidence interval	P-value
Age	0.9998	0.9809–1.0189	0.9795
Sex	1.2962	0.8811–1.9067	0.1861
Hypertension	0.9896	0.6820–1.4360	0.9563
Coronary heart disease	0.7892	0.5365–1.1611	0.2288
LA size	0.9698	0.9367–1.0041	0.0796
EF	1.0295	1.0051–1.0545	0.0164
Ablation method	0.6988	0.5419–0.9011	0.0056
AF type	0.4836	0.3506–0.6670	<0.0001
Duration of AF at inclusion	0.9855	0.9342–1.0395	0.5917
Number of ablations	0.3448	0.2406–0.4944	<0.0001
Antiarrhythmic drugs post-ablation	1.19	0.7164–1.9820	0.5003
Duration of ablation procedure	0.9939	0.9895–0.9983	0.0061

Abbreviations: LA, left atrium; EF, ejection fraction; AF, atrial fibrillation.

Figure 2 Percent of patients free from AF at different time points during follow-up.

Notes: Blue bars indicate patients treated with the PVAC; grey bars are patients treated with NavX-guided point-by-point ablation. (A) All patients; (B) patients with paroxysmal AF; and (C) patients with persistent/long-lasting persistent AF.
Abbreviations: PVAC, pulmonary vein ablation catheter; AF, atrial fibrillation; n, number.

Figure 3 Procedure and fluoroscopy times, and number of applications for ablation guided by NavX and NavX Fusion, as well as PVAC ablation, respectively.

Notes: Lines indicate SD. Differences were significant for all comparisons between PVAC and NavX or NavX Fusion. No significant differences were found between NavX and NavX Fusion.
Abbreviations: PVAC, pulmonary vein ablation catheter; SD, standard deviation.