P1395Role of PVAC therapy in the setting of recurrent atrial fibrillation

Abstract

BACKGROUND: Pulmonary vein isolation (PVI) is recognized as the cornerstone of catheter ablation strategies for the treatment of symptomatic atrial fibrillation (AF). However, there is uncertainty regarding the choice of energy source for PVI. Whilst point-to-point radiofrequency (RF) catheter ablation remains the gold-standard method for PVI, it is time-consuming and it can be challenging to create contiguous lesions. PV reconnection is frequently the cause of AF recurrence after ablation. Alternative techniques, including the circular multi-electrode Pulmonary Vein Ablation Catheter (PVAC, Medtronic Inc, MN, USA), have been developed in an attempt to improve lesion formation during PVI, and to shorten fluoroscopy and procedure time. OBJECTIVE: We aimed to evaluate the safety and effectiveness of PVAC in the treatment of recurrent paroxysmal and persistent AF at our center. METHODS: A single-centre retrospective observational study was conducted by reviewing all cases of recurrent AF for which a subsequent procedure was performed using PVAC. Data was collected on patient demographics, the duration of AF, paroxysmal or persistent AF, the number of previous ablations, and comorbid conditions (obesity, sleep apnea). Primary outcome was procedure success, measured by the absence of AF lasting more than 30 seconds on 24-hour Holter monitoring at 4 months and 12 months. Secondary outcomes were fluoroscopy time and complication rates. RESULTS: Thirty-seven patients who had previously undergone Cryoballoon ablation underwent PVACVR therapy for recurrent AF. Follow-up data at was available for 31 patients. The mean age was 60 years (range 35 - 73 years); nine patients were female, 22 were male. Fifty-eight percent (n=18) of AF cases were paroxysmal; 42% (n=13) were persistent. Mean total fluoroscopic time was 14.15 minutes (range 6.2 - 25.8 minutes). There were no reported cases of cardiac tamponade, PV stenosis, thromboembolic events nor any other intra- or post-operative complications. The overall ablation success rate was 68% (n=21) at follow-up; 72% for paroxysmal cases and 61.5% for persistent cases. CONCLUSION: Our study shows PVAC to be a safe and efficient strategy for catheter ablation of AF, with comparable success rates to those of conventional ablation strategies including point-to-point RF and Cryoballoon ablation.