Ablation of atrial fibrillation. Pulmonary vein disconnection using a circular-tipped catheter or navigation system without fluoroscopy

Aim: Both circumferential pulmonary vein ablation (CPVA) and segmental pulmonary vein isolation (SPVI) are used to treat atrial fibrillation (AF), though it is not clear which of the two techniques is preferable. Both have been analyzed in consecutive case series on a randomized basis regardless of the clinical profile involved. The present study evaluates the results of a strategy based on selection of the technique according to the clinical characteristics of the patient. Methods and results: AF ablation was carried out in 81 consecutive patients with AF refractory to pharmacological treatment. Those with a left atrial (LA) diameter £ 45 mm showing frequent atrial extrasystolia or episodes of sustained atrial tachycardia as evidenced by Holter recording were selected for SPVI, while the rest of patients were selected for CPVA. The mean duration of follow-up was 14.9±8.6 months. Global efficacy during a mean follow-up of 15±9 months was 69.8% in the SPVI group versus 81.6% in the CPVA group (p=NS). Of the patients with paroxysmal AF, 38 were selected for SPVI and 22 for CPVA - similar efficacy being recorded in both groups (76.3% vs 81.8%; p=NS). Of the patients with persistent AF, 5 were selected for SPVI and 16 for CPVA, resulting in superior efficacy in the CPVA group (20% vs 81.3%; p<0.01) Conclusions: Selection of the ablation procedure according to the findings of the Holter recording and LA diameter yields similar results in paroxysmal AF, though in persistent AF the induction of more extensive lesions with CPVA is probably necessary in all patients.