Comparison of 2 Mapping Strategies for Pulmonary Vein Isolation

BACKGROUND: Pulmonary vein (PV) isolation using a circular catheter (CC) creates an entrance block from the left atrium (LA) to PV to eliminate paroxysmal atrial fibrillation (PAF). We describe a new approach for PV isolation during distal PV pacing using a basket catheter (BC). The purpose of the present study was to compare 2 mapping strategies for PV isolation. METHODS AND RESULTS: Of 100 consecutive patients with PAF, 50 underwent CC-guided PV isolation and 50 underwent BC-guided PV isolation. During CC-guided ablation, the endpoint was the elimination of PV potentials based on the entrance block from the LA to PV. During BC-guided ablation during distal PV pacing, the endpoint was the elimination of bidirectional PV-LA conduction. At 12 months, 62% of patients who underwent CC ablation and 80% of patients who underwent BC ablation were free of symptomatic PAF without the use of antiarrhythmic drugs (p<0.05). The incidence of mild (<50%) PV stenosis in BC ablation was significantly lower than that in CC ablation (12 vs 24%, p<0.01). CONCLUSIONS: This new approach for PV isolation during distal PV pacing using BC is useful for confirming a bidirectional PV-LA conduction block and is more effective than CC ablation.