Single-catheter radiofrequency pulmonary vein isolation for atrial fibrillation: a comparative evaluation

Circular mapping catheters (CMC) are used to confirm pulmonary vein isolation (PVI) in radiofrequency (RF) ablation for atrial fibrillation (AF), but may be unnecessary in CLOSE-style point-by-point workflows. We evaluated whether omitting the CMC preserves efficacy and improves efficiency in first-time PVI.

We conducted a single-center, hybrid prospective-retrospective comparison of consecutive first-time PVI cases. A CMC-guided cohort (n = 81) underwent point-by-point RF PVI; operators were blinded to CMC electrograms during ablation and were unblinded after PVI had been verified with the ablation catheter. A subsequent CMC-free cohort (n = 245) used ablation-catheter-only verification. The primary endpoint was 12-month freedom from atrial arrhythmia (≥30 s) after a 90-day blanking period; Cox and negative binomial models were applied. Procedural metrics were secondary endpoints.

CMC-free cases had shorter procedures [105 (90, 120) vs. 120 (110, 135) min, p < 0.001], lower fluoroscopy [4 (3, 6) vs. 6 (5, 9) min, p < 0.001], and lower radiation dose [150 (96, 254) vs. 220 (167, 399) cGy·cm², p < 0.001]. RF time and energy were reduced [2,083 (1,806, 2,493) vs. 2,343 (1,977, 2,611) s, p = 0.026; 71,582 (60,527, 85,399) vs. 77,335 (68,009, 87,376) J, p = 0.035]. Twelve-month efficacy was comparable (adjusted HR: 1.03, 95% CI: 0.58-1.84; p = 0.92); recurrences did not differ (adjusted IRR: 0.61, 95% CI: 0.30-1.21; p = 0.16). On post-ablation unblinding in the CMC-guided arm, residual PV conduction was detected in 11/321 veins (3.4%).

In CLOSE-style first-time RF PVI, a CMC-free, single-catheter workflow was associated with improved procedural efficiency and no significant difference in observed 12-month arrhythmia outcomes. These findings are hypothesis-generating. Prospective randomized studies are needed to confirm the safety and efficacy of this approach.