Initial experience with the Mesh catheter for pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Background: A novel catheter design (HD Mesh ablator, Bard) combining high-density circumferential mapping and direct radiofrequency (RF) energy delivery has been developed to map and isolate the pulmonary veins (PVs). Objective: The purpose of this study was to assess the feasibility of the Mesh catheter for PV isolation in patients with paroxysmal atrial fibrillation (AF). Methods: Twenty consecutive patients (mean age 56.4 ± 12.2 years; 16 men) with paroxysmal drug-refractory AF were referred for ablation. The procedure was performed in a stepwise manner: PV isolation was initially attempted with the Mesh ablator, and if that was not successful, a conventional ablation approach was then used. Results: A total of 73 PVs including seven veins with left common ostium were targeted. Successful deployment of the Mesh was achieved in all but four veins (94.5%). Using the Mesh catheter for ablation, PV isolation was achieved in 46 (63%) of the 73 PVs. The mean (RF) ablation time required to achieve complete isolation was 12.4 ± 6.1 minutes per PV. The Mesh-only approach allowed isolation of all veins in eight (40%) patients. In combination with conventional ablation, successful PV isolation was achieved in 71 (97%) of 73 PVs. No complications attributable to the Mesh ablator occurred in this series. Conclusions: PV isolation using the Mesh catheter is feasible and may simplify the current PV isolation procedures. With the current catheter design, PV isolation could be achieved in 63% of PVs. A larger Mesh diameter with an over-the-wire design may help improve the acute success rate.