Segmental ostial ablation guided by unipolar plus bipolar recordings achieved similar electrical isolation (93% vs 96%, P=0.7) but required less radiofrequency energy (5.5 vs 7.6 min/vein, P<0.01).
RCT (n=44)
Randomized
Does segmental ostial ablation guided by unipolar plus bipolar recordings reduce radiofrequency energy duration compared to bipolar recordings alone in patients with paroxysmal atrial fibrillation?
Guiding segmental ostial ablation with both unipolar and bipolar recordings significantly reduces radiofrequency energy duration and procedure time compared to bipolar recordings alone, without compromising isolation success.
Tasa de eventos absoluta: 93% vs 96%
valor p: p=0.7
INTRODUCTION: Segmental ostial ablation to isolate pulmonary veins is guided by pulmonary vein potentials. The aim of this prospective randomized study was to compare the utility of unipolar plus bipolar electrograms versus only bipolar electrograms as a guide for segmental ablation to isolate the pulmonary veins in patients with atrial fibrillation. METHODS AND RESULTS: Isolation of the left superior, right superior, and left inferior pulmonary veins was attempted in 44 patients (35 men and 9 women; mean age 54 +/- 10 years) with paroxysmal atrial fibrillation. A decapolar Lasso catheter was positioned in the pulmonary veins, near the ostium, and a conventional ablation catheter was used for segmental ablation aimed at elimination of all pulmonary vein potentials. One hundred fourteen pulmonary veins were randomly assigned for ostial ablation guided by either bipolar or unipolar plus bipolar recordings. Electrical isolation was achieved in 51 (96%) of 53 pulmonary veins randomized to the bipolar approach, and 57 (93%) of 61 pulmonary veins randomized to the unipolar plus bipolar approach (P = 0.7). In the unipolar plus bipolar group, the total duration of radiofrequency energy needed to achieve isolation, 5.5 +/- 2.8 minutes/vein, was significant shorter than in the bipolar group, 7.6 +/- 4.1 minutes/vein (P < 0.01). Mean procedure and fluoroscopy durations per vein were 19% to 28% shorter in the unipolar plus bipolar group. CONCLUSION: Segmental ostial ablation to isolate the pulmonary veins can be achieved more efficiently and with less radiofrequency energy when guided by both unipolar and bipolar recordings than by bipolar recordings alone.
Tada et al. (Sun,) conducted a rct in Paroxysmal atrial fibrillation (n=44). Unipolar plus bipolar electrograms vs. Bipolar electrograms alone was evaluated on Electrical isolation of pulmonary veins (p=0.7). Segmental ostial ablation guided by unipolar plus bipolar recordings achieved similar electrical isolation (93% vs 96%, P=0.7) but required less radiofrequency energy (5.5 vs 7.6 min/vein, P<0.01).