Key result
Although the 35 mm high-density mesh ablator achieved higher acute pulmonary vein isolation than the 30 mm device (97% vs 79%, P<0.001), freedom from AF at 6 months was similarly low (18% vs 19%).
Why the study?
Does the 35 mm HDMA catheter improve freedom from AF at 6 months compared to the 30 mm HDMA catheter in patients with paroxysmal AF?
Observational (n=64)
Does the 35 mm HDMA catheter improve freedom from AF at 6 months compared to the 30 mm HDMA catheter in patients with paroxysmal AF?
Absolute Event Rate: 18% vs 19%
p-value: p=NS
Although the 35 mm HDMA catheter achieves higher acute pulmonary vein isolation rates than the 30 mm version, both yield disappointing long-term clinical outcomes with high AF recurrence rates due to lack of permanent isolation.
Caution against relying on acute PVI gains with larger mesh ablator; leaves open whether durable isolation is feasible with this technology.
AIMS: To analyse procedural results and clinical outcome of paroxysmal atrial fibrillation (AF) ablation using the 30 and 35 mm high-density mesh ablator (HDMA, Bard Electrophysiology). METHODS AND RESULTS: Sixty-four consecutive patients were ablated with the HDMA catheter (26 with the 30 mm, 38 with the 35 mm device). If pulmonary vein (PV) isolation was unsuccessful, ablation was continued using a conventional 4 mm ablation catheter. Success was defined as freedom of AF at 6 months after a single procedure without antiarrhythmic drugs. PV isolation could be obtained in 84/106 (79%) PVs in the 30 mm group vs. 149/153 (97%) PVs in the 35 mm group (P < 0.001). All non-isolated veins were successfully isolated with the conventional 4 mm ablation catheter. Freedom of AF at 6 months was 19% in the 30 mm group vs. 18% in the 35 mm group (P = NS). During a repeat procedure in 19 patients, 69% of the PVs were reconnected with an incremental LA-PV delay of 11 ± 15 ms compared with baseline. CONCLUSION: (i) Compared with the 30 mm, the 35 mm HDMA catheter proves to be more efficient in obtaining acute pulmonary vein isolation, (ii) despite these promising procedural results, the clinical outcome is disappointing and (iii) the high reconnection rate and the limited delay in PV potentials suggest that PV isolation with the HDMA catheter is not permanent.
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Greef et al. (2010) conducted an observational in Paroxysmal atrial fibrillation (n=64). 35 mm high-density mesh ablator (HDMA) catheter vs. 30 mm HDMA catheter was evaluated on Freedom of AF at 6 months after a single procedure without antiarrhythmic drugs (p=NS). Although the 35 mm high-density mesh ablator achieved higher acute pulmonary vein isolation than the 30 mm device (97% vs 79%, P<0.001), freedom from AF at 6 months was similarly low (18% vs 19%).
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