Influence of the anatomic characteristics of the pulmonary vein ostium, the learning curve, and the use of a steerable sheath on success of pulmonary vein isolation with a novel multielectrode ablation catheter

Anatomic variability of the pulmonary vein (PV) ostium may adversely affect isolation rates with the circular fixed-size pulmonary vein ablation catheter (PVAC). We wanted to assess the influence on PV isolation rates of anatomic characteristics of the ostium, increasing experience of four different operators, and additional use of a steerable sheath.

In the first 190 patients (pts) undergoing PVAC ablation, minimum/maximum diameter, area and shape of the PV ostia, and the length of a common ostium were analysed from computed tomography 3D reconstructions of the left atrium and related to isolation rates. In addition, a comparison was drawn between pts at the beginning and after completion (isolation of all PVs in ≥85% of pts) of the learning curve, and the effect of a steerable sheath was assessed.  Pulmonary vein isolation was achieved with the PVAC alone in 85% of pts and in 94% of veins after a median procedure and ablation time of 154 [interquartile ranges (IQR): 120, 200] and 51 (IQR: 38, 70) min. An increase in isolation rates was observed after the first 60 pts (73 vs. 90% of pts; P< 0.01; 88 vs. 96% of PVs; P< 0.001), coincident with routine use of a steerable sheath. Anatomic characteristics (larger minimum diameter and area) identified unsuccessful isolation only of the left inferior PV at the beginning of the learning curve.

Pulmonary vein isolation rates using this catheter are high. Anatomic variability of PV ostia modestly affects PV isolation rates. Standard use of a steerable sheath plays a major role in increasing isolation rates and overcoming ‘difficult’ anatomies.