Radiofrequency ablation of the pulmonary veins using a single-catheter method is as effective as the traditional approach in the treatment of paroxysmal atrial fibrillation

Aim. To conduct a comparative analysis of the efficacy and safety of radiofrequency ablation (RFA) of pulmonary vein (PV) in patients with paroxysmal atrial fibrillation (AF) using a single-catheter method (experimental group) versus the standard technique with a multipolar diagnostic Lasso catheter (Biosense Webster, Johnson & Johnson, USA) (control group).

Methods. A single-center prospective randomized study included 206 patients with paroxysmal AF, randomized into two groups: single-catheter (n=103) and control (n=103). All procedures utilized the CARTO 3 (Biosense Webster, Johnson & Johnson, USA) 3D electroanatomical mapping system, and PV isolation was performed according to the CLOSE protocol based on the ablation index. In the experimental group, only a navigated ablation catheter was used for mapping and ablation, with verification of conduction block (entrance and exit) via stimulation from the ablation electrode. The control group underwent the standard approach with a circular diagnostic Lasso catheter. The primary endpoint was the absence of atrial arrhythmias (AF/atrial flutter) after 12 months of follow-up.

Results. Procedure efficacy after a median follow-up of 400 days was 83.5% (86/103 patients) in the single-catheter group and 78.7% (81/103) in the control group. The difference between groups was not statistically significant (OR 1.298; 95% CI 0.649-2.595; p=0.354). Kaplan-Meier analysis also revealed no significant differences (log-rank test, p=0.405). The first-pass PV isolation rate was comparable between groups (94.2% vs. 93.2%, p=0.874). The total procedure time was statistically significantly shorter in the single-catheter group (65.3±20.0 min vs. 82.2±13.0 min, p=0.011), while fluoroscopy time and RFA duration did not differ significantly. Three periprocedural complications were recorded (1 in the experimental and 2 in the control group), all of them were managed successfully.

Conclusion. Radiofrequency ablation of pulmonary veins using a single-catheter method is not inferior in efficacy to the standard approach utilizing a circular Lasso catheter in patients with paroxysmal atrial fibrillation. 

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