BACKGROUND: Circumferential radiofrequency catheter ablation (RFCA) around the orifices of the pulmonary veins (PV) is a curative catheter-based therapy of paroxysmal, persistent, and permanent atrial fibrillation (AF). Integration of multislice computed tomography into three-dimensional electroanatomic mapping to guide catheter ablation has been shown to be accurate and feasible. This study investigated whether the use of such sophisticated imaging technology translates into better clinical outcomes, procedural efficacy, and safety in comparison with a control group treated with conventional three-dimensional electroanatomic mapping. METHODS: A total of 100 consecutive patients (85 male, mean age 55 +/- 9 years) with multi-drug-resistant AF underwent RFCA. In this study we used a wide area circumferential approach with confirmed PV isolation (requiring additional ablations at the ostial level) and further lines as needed. RESULTS: Comparison of outcome data between the conventional electroanatomic mapping (Carto XP, Biosense Webster, Diamond Bar, CA, USA) and the image integration technology (Carto MERGE, Biosense Webster) resulted in a significant improvement in procedural success for the image integration group (85.1% vs 67.9%; P = 0.018). No single case of significant PV stenosis occurred in the Carto MERGE group versus three significant stenoses in the conventional group (P = 0.098). Both procedure and fluoroscopy times remained unchanged. CONCLUSION: Multislice computed tomography image integration into electroanatomic mapping significantly improves the success of wide area circumferential ablation with confirmed isolation of the PV and additional lines. In addition, the safety of radiofrequency ablation with regard to the occurrence of PV stenosis is increased in comparison with a control group using conventional electroanatomic mapping alone. Procedural efficacy remains unchanged.
BACKGROUND: Circumferential radiofrequency catheter ablation (RFCA) around the orifices of the pulmonary veins (PV) is a curative catheter-based therapy of paroxysmal, persistent, and permanent atrial fibrillation (AF). Integration of multislice computed tomography into three-dimensional electroanatomic mapping to guide catheter ablation has been shown to be accurate and feasible. This study investigated whether the use of such sophisticated imaging technology translates into better clinical outcomes, procedural efficacy, and safety in comparison with a control group treated with conventional three-dimensional electroanatomic mapping. METHODS: A total of 100 consecutive patients (85 male, mean age 55 +/- 9 years) with multi-drug-resistant AF underwent RFCA. In this study we used a wide area circumferential approach with confirmed PV isolation (requiring additional ablations at the ostial level) and further lines as needed. RESULTS: Comparison of outcome data between the conventional electroanatomic mapping (Carto XP, Biosense Webster, Diamond Bar, CA, USA) and the image integration technology (Carto MERGE, Biosense Webster) resulted in a significant improvement in procedural success for the image integration group (85.1% vs 67.9%; P = 0.018). No single case of significant PV stenosis occurred in the Carto MERGE group versus three significant stenoses in the conventional group (P = 0.098). Both procedure and fluoroscopy times remained unchanged. CONCLUSION: Multislice computed tomography image integration into electroanatomic mapping significantly improves the success of wide area circumferential ablation with confirmed isolation of the PV and additional lines. In addition, the safety of radiofrequency ablation with regard to the occurrence of PV stenosis is increased in comparison with a control group using conventional electroanatomic mapping alone. Procedural efficacy remains unchanged.
Authors: Alexander C Perino; George C Leef; Andrew Cluckey; Fahd N Yunus; Mariam Askari; Paul A Heidenreich; Sanjiv M Narayan; Paul J Wang; Mintu P Turakhia Journal: Am Heart J Date: 2018-10-29 Impact factor: 4.749
Authors: Sean D Pokorney; Bradley G Hammill; Laura G Qualls; Benjamin A Steinberg; Lesley H Curtis; Jonathan P Piccini Journal: Am J Cardiol Date: 2014-05-02 Impact factor: 2.778
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343