Comments about the Medtronic PVAC Pulmonary Vein Ablation Catheter | Which Medical Device

A real advance when it was first introduced, this catheter aims to facilitate multiple lesions around the pulmonary vein orifices, thus allowing the procedure to be done in a shorter time, and through one trans septal puncture.

The catheter is designed as a spiral whch unfurls to a circle as it leaves the supporting shaeth (usually the Bard 9F Channel sheath). The specially designed PVAC support wire runs through the central lumen and into the vein, whilst the eccentrically placed ablation electrodes are opposed against the ostium of the vein

The device is supported by a new design of ablator which allows the delivery of independent teperature controled ablation at all five pairs of two poles.

There is no doubt that this catheter can produce transmural lesions, and that rapid isolation of all four veins can be achieved.

Care needs to be taken to avoid intubating the veins too deeply. Where veins are large or where there is a common orifice, it is difficult to be certain of complete isolation. True antral isolation is more difficult with this catheter than with standard point to point ablation.

This operator's experience is that it is difficult to check PV isolation with this catheter, especialy in AF.

Until recently we have been unable to display this catheter on a 3D mapping system. This may change with the new version of velocity.

There have been some concerns about thrombotic risk, and about pulmonary vein stenosis, but the limited (non randomised) data that there are do not suggest a higher tamponade rate. It is possible that the tamponade rate will be lower, possibly related to the non traumatic nature of the tip, and the need for only one transseptal puncture.

It takes a small amount of practice to get used to using it, and all four veins can be cannulated in the majority of patients.

It would be nice if it would fit into the more manoeverable and cheaper agilis sheath!