To evaluate whether omitting the circular mapping catheter (CMC) preserves efficacy and improves efficiency in first-time pulmonary vein isolation (PVI) during radiofrequency (RF) ablation for atrial fibrillation (AF), addressing a gap in current clinical practices.
Approach:
Key Findings:
CMC-free cases had shorter procedures (105 vs. 120 min, p < 0.001), indicating improved efficiency.
Lower fluoroscopy time in CMC-free cases (4 vs. 6 min, p < 0.001), which may reduce patient exposure to radiation.
Reduced radiation dose in CMC-free cases (150 vs. 220 cGy·cm2, p < 0.001), enhancing safety.
RF time and energy were lower in CMC-free cases (2083 vs. 2343 s, p = 0.026; 71582 vs. 77335 J, p = 0.035), suggesting a more efficient procedure.
12-month efficacy was comparable between groups (adjusted HR: 1.03, 95% CI: 0.58–1.84; p = 0.92), supporting the non-inferiority of the CMC-free approach.
Recurrences did not differ significantly (adjusted IRR: 0.61, 95% CI: 0.30–1.21; p = 0.16), indicating similar long-term outcomes.
Interpretation:
In CLOSE-style first-time RF PVI, a CMC-free workflow improved procedural efficiency without significant differences in 12-month arrhythmia outcomes, suggesting potential for broader application in clinical practice.
Limitations:
The study was non-randomized, which may introduce selection bias; future studies should consider randomized designs to validate findings.
Findings are hypothesis-generating and require confirmation through prospective randomized studies to establish safety and efficacy.
Conclusion:
The CMC-free approach may enhance efficiency in RF PVI for AF without compromising efficacy, warranting further investigation to confirm its impact on patient care.
Evidence suggests improved outcomes in selected patients with cardiac arrest, but limited data, complications, and resource demands may restrict broader use.
