Abstract:Objective To compare the efficacy and safety of “piledriving” concept and technique in the ablation of left pulmonary vein anterior triangle during atrial fibrillation (AF) ablation procedure with that of traditional concept and technique. Methods Consecutive 56 patients with paroxysmal AF admitted to Department of Cardiology of First Medical Center of Chinese PLA General Hospital from June 2018 to December 2020 were enrolled, and then randomly assigned into piledriving group and traditional group, with 28 patients in each group. Their baseline data, including age, gender, body mass, history of paroxysmal AF and left atrial diameter were collected and compared. After preoperative examinations, ablation procedure were performed. The patients from the piledriving group were given special piledriving-like ablation at the anterior triangle of left pulmonary vein while those of the traditional group received routine ablation at the anterior triangle. SPSS statistics 21.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test or Chi-square test depending on data type. Results The “piledriving” group demonstrated significantly shorter left pulmonary isolation time [(39.6±6.2) vs (62.5±8.7) min], bilateral pulmonary isolation time [(106.3±12.8) vs (123.9±17.5) min] and total procedure time [(176.4±29.1) vs (201.2±33.8) min], and obtained obviously higher rate of single circle isolation for left pulmonary vein [82.1% (23/28) vs 60.7% (12/28)] when compared with the traditional group (all P<0.05). There were no statistical differences in the incidence rates of vagus nerve reflex, perioperative adverse events, cardiac tamponade or recurrence during one-year follow-up period. Conclusion Piledriving is a stable and reliable technique for AF ablation, with the advantages of shortening ablation time at the anterior triangle of left pulmonary and improving the rate of single circle isolation for left pulmonary vein, and thus facilitates the total efficiency of surgical procedure. It shows satisfied safety with no elevated adverse reactions, and is an effective measure to deal with operational difficulties due to local anatomical structure.