Comparison Of Circumferential Pulmonary Vein Bicyclo-ablation With Monocyclic Ablation In Paroxysmal Atrial Fibrillation Therapy

Objective:Our investigations were designed to compare the effects of circumferential pulmonary vein (PV) bicyclo-ablation (BA) on paroxysmal atrial fiblillation (PAF) with monocyclic ablation (MA).Method:These 45-63 years old patients of PAF, which presented resistance to anti-arrhythmia drugs or who affected serious adverse effects from anti-arrhythmia drugs, were examined to exclude hyperthyreosis, heart failure been not controled or other serious heart diseases and left atrium thromb by thyroid gland function assay, routine examinations and multislice spiral CT, which can exactly display anatomy variation of pulmonary vein to judge whether pulmonary vein is stenosal or not after operation, respectively. Forty cases of patient corresponded with the case index were randomly assigned into bicyclo-ablation group (BA) and monocyclic ablation group (MA), and each group included 20 cases of patient. The patients of MA were made monocyclic electricity isolation line 0.5 cm off the PV ostium, but the patients of BA were again made monocyclic electricity isolation line 1 cm off the PV ostium. Before operation,24 hours dynamic electrocardiogram was performed to determine the function of atrionector and atrioventricular node to judge the ablation effect and detect the potential arrhythmia complications after operation. Atrial septum puncture was performed through femoral vein to put mapping catheter and ablation electrode catheter, then heparin (100U/kg) was promptly injected from vein. Pulmonary phlebography was immediately performed to display the PV size and the site of PV ostium for the choice of the electricity isolation line and the mapping catheter, and the left atrium three diamensions model was reconstructed by mapping spot of left atrium and Ensite 3000 system. After deciding the site of the PV ostium by pulmonary phlebography, drop-off zone together with potential characteristic, dot-by-dot ablation and mapping was done at cardiac atrium latus 0.5 cm or 1 cm off the PV ostium, then these dots were linked into line and these lines were again linked into loop. It was the ablation end that the decreasing of the clectrocardiogram swing exceeded 80%, or the electric discharge lasted for 30s. Furthermore, it was confirmed whether PV electric potential in ablation link disappeared or not. If PV electric potential was still present, ablation was added till the complete disappearing of PV potential. All patients took ACEI and Amiodarone Hydrochloride to keep sinus rhythm operation after. The utility rate, PV stenosis, atrial arrhythmia and pericardial tamponade were compared between the two groups six and twelve months after operation.Resultssix months after operation, the utility rate of MA and BA was 90% and 95%, respectively (P>0.05), but the second cure rate of BA (95%) obviously exceeded the second cure rate of MA (90%) (P<0.05) twelve months after operation. It was still inspiring that the incidence of atrial arrhythmia in MA surpassed the incidence in BA (P<0.05) six and twelve months after operation, and pulmonary vein stenosis was not discovered in MA and BA.Conclusion circumferential PV bicyclo-ablation outweighed monocyclic ablation.