Conventional radiofrequency catheter ablation compared to multi-electrode ablation for atrial fibrillation

Background: Limited data is available on long-term atrial fibrillation (AF) free survival after multi-electrode catheter pulmonary vein isolation (PVI). The aim of this study was to compare point-by-point PVI to multi-electrode PVI in terms of procedural characteristics and long-term AF free survival.

Methods and results: 460 consecutive patients were randomly allocated: 230 patients underwent conventional, point-by-point ablation with a radiofrequency ablation catheter (cPVI group) and 230 patients underwent multi-electrode, phased radiofrequency ablation (MER group). Median follow-up was 43 months. Mean age was 56 years, 82% of patients had paroxysmal AF. Baseline characteristics did not differ among catheter groups. Acute electrical PVI was achieved in 99.7% of pulmonary veins, with no differences among catheter groups. Procedure time and ablation time were significantly shorter in the MER group. There were significantly less complications in the MER group (4.8% vs. 1.3%, P=0.025). After a mean of 1.5 procedures, AF free survival without the use of antiarrhythmic drugs was 74% at 1 year and 46% at 5 years follow-up and did not differ among catheter groups (cPVI group 45%, MER group 48%, P=0.777). In multivariate analysis, BMI, AF duration and CHADSVASc score were predictors of AF free survival.

Conclusion: Multi-electrode ablation was superior in procedure duration and ablation time, with less complications. However, both conventional point-by-point PVI and multi-electrode PVI achieved a high acute PVI success rate and showed a comparable long-term AF free survival.