High Voltage Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulmonary vein (PV) antrum ablation is standard for pulmonary vein isolation (PVI) in atrial fibrillation (AF).
• Targeting critical ablation sites can improve PVI success and reduce AF recurrence.
• A voltage-guided circumferential PV ablation (CPVA) strategy warrants investigation.

Purpose of the Study:

• To investigate the short-term outcomes of a novel voltage-guided CPVA strategy.
• To compare the efficacy of voltage-guided CPVA versus standard CPVA for paroxysmal AF.

Main Methods:

• Prospective pilot study including patients with paroxysmal AF.
• Utilized the EnSite NavX system for 3D left atrium (LA) geometry and voltage mapping.
• Performed voltage-guided CPVA targeting high-voltage sites, followed by gap elimination, and compared to standard CPVA.

Main Results:

• Thirty-four patients with paroxysmal AF were included (14 voltage-guided, 20 standard).
• Mean voltage in PV antra was recorded (Right: 1.7±0.1 mV, Left: 1.9±0.2 mV).
• A trend towards reduced radiofrequency time was observed in the voltage-guided group (40.9±17.4 vs. 48.1±15.5 mins).

Conclusions:

• Voltage-guided CPVA is a promising strategy for PV isolation.
• This method shows a trend towards lower AF recurrence in the short term compared to standard CPVA.
• Further studies are needed to confirm these findings.