Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system

Background-We treated paroxysmal recurrent atrial fibrillation (AF) with ra diofrequency (RF) catheter ablation by creating long linear lesions in the atria. To achieve line continuity, a 3D electroanatomic nonfluoroscopic map ping system was used. Methods and Results-In 27 patients with recurrent AF, a catheter incorporat ing a passive magnetic field sensor was navigated in both atria to construc t a 3D activation map. RF energy was delivered to create continuous linear lesions: 3 lines (intercaval, isthmic, and anteroseptal) in the right atriu m and a long line encircling the pulmonary veins in the left atrium. After RF application, the atria were remapped to validate completeness of the blo ck lines, demonstrated by late activation of the areas circumscribed by the lines. The mean procedure duration was 312+/-103 minutes (range, 187 to 49 5), with mean fluoroscopy time of 107+/-44 minutes (range, 32 to 185 minute s). No acute complications occurred, but 1 patient experienced early prolon ged sinus pauses and received a pacemaker. During the first day, 17 patient s (63%) had AF episodes, but at discharge, 25 patients were in sinus rhythm . After a follow-up of 6.0 to 15.3 months (average, 10.5+/-3.0 months), 16 patients are asymptomatic, 3 have an almost complete disappearance of sympt oms, 1 patient is improved, and 7 patients have their AF attacks unchanged. Conclusions-Paroxysmal recurrent drug-refractory AF can be treated by RF ca theter ablation. Creation of long continuous linear lesions necessary to co mpartmentalize the atria is facilitated by a nonfluoroscopic electroanatomi c mapping system.