SPC365

Isolation of pulmonary veins with duty-cycled circular multi-polar catheter

Session: Comunicações Orais (Sessão 13) - Arritmias 3 - Fibrilhação auricular
Speaker: Ana Lobato de Faria Abrantes

Congress: CPC 2022
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Lobato de Faria Abrantes; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Margarida Martins; Ana Beatriz Garcia; Catarina Simões de Oliveira; Afonso Nunes-Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: The isolation of pulmonary veins (IPV) is the central element in the ablation of atrial fibrillation (AF) and can be obtained with different ablation modalities. The duty-cycled circular multi-pole catheter PVAC allows linear application of radiofrequency energy with the production of circumferential lesions. Conceptually, it can make ablation simpler and faster in patients with favorable anatomy.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Objectives: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">To evaluate the safety and efficacy of ablation with a PVAC catheter and to compare it with the conventional point-to-point, with irrigated catheter technique (TCv).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Single-center retrospective study of consecutive AF patients (pts) refractory to antiarrhythmic therapy and submitted to ablation with PVAC or TCv. The ablation strategy consisted of IPV, complemented with ablation of the cavo-tricuspid isthmus in pts with a history of concomitant flutter. Monitoring was performed with a 7-day event recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by AF-free survival or any maintained supraventricular tachycardia. Kaplan-Meier survival curves were used to estimate the risk of events. The groups were compared using Chi-square and Mann-Whitney analysis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> We included 629 patients (67.2% males, 60&plusmn;12 years, TCv: 319, PVAC: 310), 56.9% with paroxysmal AF, 23.7% with short duration persistent AF and 13.5% with long-standing persistent AF. There were no differences between the two groups. The mean follow-up period was 1224&plusmn;1567 days. Among the PVAC treated patients, acute success rate of IPV was similar to that of the TCv group (99.7%vs97.8%, p=0.092). PVAC patients presented lower complication</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">&nbsp;rate (PVAC:4.1%vsTCv:9.9%, p=0.006) and lower hemopericardium risk (0% vs 3.4%; p=0.01). Three patients treated with PVAC developed stroke (1%vs0.9%; p=0.972). Procedure time was lower among the patients treated with PVAC [120(90-155)vs225(180-250)min; p&lt;0.001], as well as the fluoroscopy time [20(12-29)vs25.5(14.0-35.6)min; p&lt;0.001]. PVAC presented a trend for superior success rate after first intention ablation at 36 months (66.4%vs56.7%; p=0.56; figure 1). In the PVAC group, when considering multiple ablations, the success rate increased 22.9%, however without statistical difference between groups (p=0.49).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">: The multipolar PVAC catheter can represent an added value in AF ablation, making the procedure simpler and faster, ensuring similar efficacy to the TCv and with a lower risk of complications.</span></span></span></p>