Method, safety, and outcomes of persistent AF ablation without a circular mapping catheter: 3 years experience of a Belgian Tertiary Centre.

BACKGROUND: We aimed to share our methods and experience of persistent AF ablation without a circular mapping catheter (CMC), thereby avoiding femoral venous and transseptal punctures, decreasing the cost of the procedure, and possibly reducing the duration of the procedure and fluoroscopy time. METHODS: We report our experience with 261 persistent AF ablations performed without a CMC over the past 3 years. RESULTS: The procedures were performed with no apparent loss of efficacy or safety. Freedom from recurrence was defined as a 1-year absence of AF/atrial flutter (AFL) episodes >30 s, beyond the 3-month blanking period. At 1 year, 72% of the patients were free from arrythmias. CONCLUSIONS: Persistent AF ablation is feasible without a CMC, reducing the need for venous and transseptal punctures and the cost of the procedure. We suggest that prospective studies should aim to characterise the reduction in procedure and fluoroscopy times as a result of this technique.

3D navigation system allows remarkable reduction in fluoroscopy use during cavo-tricuspid isthmus ablation.

PURPOSE: Typical atrial flutter (AFL) is one of the most common supraventricular arrhythmias. Its treatment mainly relies on cavo-tricuspid isthmus (CTI) ablation, which can be performed either using conventional fluoroscopy, still mainly used, or 3D navigation system to track the position of the catheter. The aim of this study is to show that the use of a 3D navigation system allows a dramatic reduction of fluoroscopy use during CTI ablation, without any loss of efficacy, time, or safety. METHODS: In this single-center study, we retrospectively compared 134 cases of CTI ablation performed for typical AFL without a 3D navigation system with 95 cases of CTI ablation performed with such a 3D system. We compared the rates of procedural success (defined as obtaining a bidirectional electrical conduction block), freedom from AFL recurrence at 1-year follow-up, procedural time and safety, and fluoroscopy use. RESULTS: Compared to conventional fluoroscopy, the use of a 3D navigation system significantly decreased the duration of fluoroscopy use (2 min 13 s ± 2 min 16 s versus 14 min 41 s ± 10 min 39 s, p < 0.0001) and dose-area products (1567.9 ± 1329.5 mGy cm2 versus 8263.3 ± 8636.6 mGy cm2, p < 0.0001). Procedure success rates, duration, and safety were not different between groups. CONCLUSIONS: The use of 3D navigation during CTI ablation substantially reduces fluoroscopy use duration, without reducing the success rates and safety or prolonging the procedure duration, as compared to conventional fluoroscopy. We therefore suggest the generalization of this navigation system.

A circular mapping catheter is not mandatory for isolating pulmonary veins during paroxysmal atrial fibrillation ablation with radiofrequency.

PURPOSE: In this study, we evaluated the feasibility, efficacy, and safety of radiofrequency ablation of paroxysmal atrial fibrillation (AF) with the use of an ablation catheter only (non-CMC group) by retrospectively comparing its procedural success and recurrence rates at 1 year to ablation performed with the help of a circular mapping catheter (CMC group). METHODS: We compared the success and recurrence rates between 226 patients and 251 patients who underwent index ablation with and without the use of CMC, respectively. RESULTS: Freedom from recurrence was defined as a 1-year absence of AF/atrial tachycardia (AT) episodes > 30 s, beyond the 3-month blanking period. There was no significant difference between the number of pulmonary vein isolations, recurrence rate of AF/AT, and the use of antiarrhythmic drugs after 1 year of ablation. The procedure and fluoroscopy times were lower in the non-CMC group compared with the CMC group (106 ± 33 vs. 125 ± 32 min, p < 0.0001; 2.2 ± 1.9 vs. 2.7 ± 2.3 min, p = 0.0002, respectively). CONCLUSIONS: Pulmonary vein isolation without the use of a CMC is feasible; moreover, the material costs, procedure time, and radiation exposure were reduced compared with the CMC group. Freedom of recurrence was similar between groups. Optimized use of 3D electro-anatomical mapping systems could reduce the radiation exposure for both the patient and physician.