Key result
PVAC ablation resulted in significantly lower freedom from atrial arrhythmia at 12 months compared to point-by-point RF ablation (35.70% vs 52.80%, P=0.01), though procedural times were reduced.
Why the study?
Although multipolar phased PVAC reduces procedural time for AF ablation compared to traditional catheters, its efficacy compared to point-by-point RF ablation needed evaluation.
Does multipolar phased pulmonary vein ablation catheter (PVAC) improve freedom from atrial arrhythmia compared to point-by-point radiofrequency ablation in patients with symptomatic, paroxysmal AF?
Cohort (n=230)
Yes
Does multipolar phased pulmonary vein ablation catheter (PVAC) improve freedom from atrial arrhythmia compared to point-by-point radiofrequency ablation in patients with symptomatic, paroxysmal AF?
PVAC is associated with reduced procedural times but lower overall freedom from AF compared to point-by-point RF ablation, although efficacy is comparable when using the newer PVAC-Gold for stand-alone PV isolation.
Answers are grounded in this paper and cite their sources.
PVAC was associated with lower arrhythmia freedom than point-by-point ablation in this cohort; leaves open whether updated catheters warrant randomized evaluation.
BACKGROUND: Multipolar phased pulmonary vein ablation catheter (PVAC), specifically its second-generation (PVAC-Gold), has been associated with reduced procedural time for atrial fibrillation (AF) ablation compared to traditional catheters. We performed this study to compare the efficacy of PVAC with point-by-point radiofrequency (RF) ablation. METHODS: This is a multicenter-cohort study (2012-2017), involving patients with symptomatic, paroxysmal AF refractory to at least one antiarrhythmic medication. Overall, 230 patients were enrolled to (A) PVAC and (B) control groups. Subanalyses were done for ablations performed with PVAC-Gold, and for ablations performed without left atrial (LA) ablation in addition to pulmonary vein isolation. Electrocardiogram and 48-h Holter monitoring were used to assess patients at 3, 6, 9, and 12 months postablation. Recurrence was defined as any atrial arrhythmia >30 s excluding an initial 3-month blanking period. RESULTS: Freedom from any atrial arrhythmia at 12 months postablation was 35.70% and 52.80% in groups A and B, respectively (P = .01). Freedom from atrial arrhythmia was not significantly different when limiting the PVAC cohort to PVAC-Gold and excluding patients with additional LA ablation (A: 44.30%; B: 44.30%, P = .80). Procedural and ablation time was significantly lower in group A than B. Multivariate regression model showed female gender (odds ratio [OR] = 2.90) and recurrence during blanking period (OR = 6.60) as significant predictors of recurrence. CONCLUSION: This study suggests that PVAC may achieve less freedom from AF than point-by-point RF; however, efficacy is similar when comparing PVAC-Gold and point-by-point stand-alone PV isolation. PVAC is associated with significantly reduced procedural times for AF ablation.
No takes yet. Share an insight, caveat, or question.
Essebag et al. (2019) conducted a cohort in symptomatic, paroxysmal atrial fibrillation (n=230). Multipolar phased pulmonary vein ablation catheter (PVAC) vs. Point-by-point radiofrequency (RF) ablation was evaluated on Freedom from any atrial arrhythmia at 12 months postablation (p=.01). PVAC ablation resulted in significantly lower freedom from atrial arrhythmia at 12 months compared to point-by-point RF ablation (35.70% vs 52.80%, P=0.01), though procedural times were reduced.
Synapse has enriched 10 related papers. Consider them for comparative context: