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MARCELLI E, PIRANI S, CORAZZA I, CERCENELLI L. ELECTROLOC: A SIMPLE, FAST AND ACCURATE SYSTEM FOR LOCALIZATION OF ENDOCARDIAL CATHETERS. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415500621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accurate positioning of endocardial catheters inside cardiovascular structures is crucial in electrophysiology (EP) procedures. Improvements in cardiac mapping are required for a better understanding and treatment of arrhythmias. The proposed Electroloc system is a simple, fast and accurate method for endocardial catheters localization. The key features of Electroloc are the use of conventional EP catheters and the simple data processing for providing localization. Electroloc is able to locate any conventional EP mapping catheter with respect to a noncontact EP catheter used as reference, by sequentially passing a sub-threshold current between the mapping electrode (ME) of the mapping catheter and each electrode of the reference catheter. This creates different potential gradients across the reference catheter used to compute two spatial coordinates (horizontal and vertical coordinates) intended for positioning the ME in the cardiac chamber. In vitro experiments demonstrated that Electroloc is a reliable and sensitive system for localizing the ME with a spatial resolution of 2 mm in the vertical localization and of 5 mm in the horizontal localization. Further studies will be required to improve Electroloc accuracy and to extend its sensitivity range.
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Affiliation(s)
- E. MARCELLI
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - S. PIRANI
- Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, Italy
| | - I. CORAZZA
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - L. CERCENELLI
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
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Rolf S, Hindricks G, Sommer P, Richter S, Arya A, Bollmann A, Kosiuk J, Koutalas E. Electroanatomical mapping of atrial fibrillation: Review of the current techniques and advances. J Atr Fibrillation 2014; 7:1140. [PMID: 27957132 PMCID: PMC5135200 DOI: 10.4022/jafib.1140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 01/07/2023]
Abstract
The number of atrial fibrillation (AF) catheter ablations performed annually has been increasing exponentially in the western countries in the last few years. This is clearly related to technological advancements, which have greatly contributed to the improvements in catheter ablation of AF. In particular, state-of-the-art electroanatomical mapping systems have greatly facilitated mapping processes and have enabled complex AF ablation strategies. In this review, we outline contemporary and upcoming electroanatomical key technologies focusing on new mapping tools and strategies in the context of AF catheter ablation.
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Affiliation(s)
- Sascha Rolf
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gerhard Hindricks
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Philipp Sommer
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Richter
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Arash Arya
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andreas Bollmann
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Jedrzej Kosiuk
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Emmanuel Koutalas
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1141] [Impact Index Per Article: 95.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1299] [Impact Index Per Article: 108.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
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Matsuo S, Yamane T, Tokuda M, Date T, Hioki M, Narui R, Ito K, Yamashita S, Hama Y, Nakane T, Inada K, Shibayama K, Miyanaga S, Yoshida H, Miyazaki H, Abe K, Sugimoto KI, Taniguchi I, Yoshimura M. Prospective randomized comparison of a steerable versus a non-steerable sheath for typical atrial flutter ablation. Europace 2010; 12:402-409. [DOI: 10.1093/europace/eup434] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Callahan TD, Di Biase L, Horton R, Sanchez J, Gallinghouse JG, Natale A. Catheter Ablation of Atrial Fibrillation. Cardiol Clin 2009; 27:163-78, x. [DOI: 10.1016/j.ccl.2008.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Atrial fibrillation is a common arrhythmia associated with significant morbidity including angina, heart failure and stroke. Medical therapy remains suboptimal with significant side effects and toxicities, as well as a high recurrence rate. Catheter ablation or modification of the atrio-ventricular node with pacemaker implantation provides rate control but subjects the patient to the risks of an implantable device and does nothing to reduce the risk of stroke. Pulmonary vein antrum isolation offers a nonpharmacologic means of restoring sinus rhythm, thereby eliminating the morbidity of atrial fibrillation and the need for anti-arrhythmic drugs.
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Affiliation(s)
- Thomas D Callahan
- Cardiac Pacing and Electrophysiology, Cleveland Clinic, F15, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Estner HL, Hessling G, Luik A, Reents T, Konietzko A, Ucer E, Wu J, Kolb C, Zrenner B, Deisenhofer I. [Use of the NavX navigation system in ablation of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2007; 18:131-9. [PMID: 17891489 DOI: 10.1007/s00399-007-0573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 06/27/2007] [Indexed: 11/25/2022]
Abstract
Catheter ablation, notably the electric isolation of pulmonary veins, has become a well-established therapeutic approach in symptomatic atrial fibrillation. The NavX navigation system has been described to facilitate pulmonary vein isolation in patients with AF. EnSite NavX (Endocardial Solutions, St. Jude Medical, Inc., St. Paul, MN, USA) is a novel navigation system that measures the local voltage on every standard intra-cardiac electrode and calculates the electrode position in three-dimensional (3D) space. Any individual electrode of each catheter in 3D-space can be displayed and labelled individually. The geometry of any cardiac chamber can be reconstructed and additional information, e.g. electrical activation spreading, can be displayed colour coded on the surface. Recent studies investigating the possible advantages of this system in the ablation of persistent or paroxysmal atrial fibrillation are summarized. All reports showed a significant reduction in fluoroscopy and procedure time by the use of the NavX system compared to conventional fluoroscopic catheter guidance. This benefit can be obtained with simple visualisation of all intracardiac catheters alone or with additional reconstruction of the left atrium and pulmonary veins.
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Affiliation(s)
- H L Estner
- Deutsches Herzzentrum München, Lazarettstrasse 36, 80636, München, Germany.
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Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJG, Damiano RJ, Davies DW, Haines DE, Haissaguerre M, Iesaka Y, Jackman W, Jais P, Kottkamp H, Kuck KH, Lindsay BD, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Natale A, Pappone C, Prystowsky E, Raviele A, Ruskin JN, Shemin RJ. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4:816-61. [PMID: 17556213 DOI: 10.1016/j.hrthm.2007.04.005] [Citation(s) in RCA: 886] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Estner HL, Deisenhofer I, Luik A, Ndrepepa G, von Bary C, Zrenner B, Schmitt C. Electrical isolation of pulmonary veins in patients with atrial fibrillation: reduction of fluoroscopy exposure and procedure duration by the use of a non-fluoroscopic navigation system (NavX®). ACTA ACUST UNITED AC 2006; 8:583-7. [PMID: 16831837 DOI: 10.1093/europace/eul079] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The aim of the study was to investigate the feasibility of performing segmental pulmonary vein (PV) isolation guided by the NavX (Endocardial Solutions, St Jude Medical, Inc., St Paul, MN, USA) system without the three-dimensional (3D) geometric reconstruction option and whether the use of NavX system will reduce the radiation exposure and procedure duration. METHODS AND RESULTS The study included 64 patients with symptomatic paroxysmal or permanent atrial fibrillation, in whom PV isolation was performed using fluoroscopic guidance (n=32) or the NavX system (n=32). Pulmonary vein mapping with a circular mapping catheter allowed the identification and localization of myocardial connections between the PV and the left atrium. PV isolation was performed by radiofrequency ablation of these connections at the atrial aspect of the PV ostium. Primary success rate for isolated PVs did not differ significantly in patients ablated under fluoroscopic guidance vs. those ablated under guidance of NavX system [100/107 PVs (93.5%) vs. 120/124 PV (96.8%; P=n.s.)]. Compared with fluoroscopy guided procedures, NavX-guided procedures showed a significant reduction in the fluoroscopy time (75.8+/-24.5 vs. 38.9+/-19.3 min, P<0.05), total X-ray exposure (93.2+/-51.6 vs. 56.6+/-37.9 Gy cm(2), P=0.03), and total procedural time (237.7+/-65.4 vs. 188.6+/-62.7 min, P=0.01). The mean follow-up was 9.5+/-3.0 months. One patient in each group was lost to follow-up. Seven-day Holter monitoring showed that 23 of 31 patients (74.2%) in the NavX-guided group and 21 of 31 patients (67.7%) in the fluoroscopy-guided group were in sinus rhythm (P=0.57). CONCLUSION The 3D visualization of the catheters by NavX system allows a rapid and precise visualization of the mapping and ablation catheters at the PV ostia and markedly reduces fluoroscopy time, total X-ray exposure, and procedural duration during PV isolation compared with ablation performed under fluoroscopy guidance.
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Affiliation(s)
- Heidi Luise Estner
- Deutsches Herzzentrum München, 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Lazarettstrasse 36, D-80636 München, Germany.
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Melo JQ. Surgery for atrial fibrillation: Are we heading in the right direction? J Thorac Cardiovasc Surg 2006; 131:949-51. [PMID: 16678573 DOI: 10.1016/j.jtcvs.2005.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 12/29/2005] [Indexed: 11/24/2022]
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Paisey JR, Yue AM, White A, Moss A, Morgan JM, Roberts PR. Radiation peak skin dose to risk stratify electrophysiological procedures for deterministic skin damage. Int J Cardiovasc Imaging 2005; 20:285-8. [PMID: 15529910 DOI: 10.1023/b:caim.0000041943.73199.d3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED Ionising radiation is has the potential to cause harm both by increasing the probability future malignancy (stochastic mechanisms) and by direct physical injury (deterministic mechanisms). Several measures have been developed to quantify radiation exposure during a procedure and cardiologists usually refer to fluoroscopic screening time (FST). FST, however, has limitations for predicting deterministic injury which is directly dependant on peak skin dose (PSD). We compared FST to PSD for a range of interventional cardiac electrophysiology procedures. METHODS All patients undergoing electrophysiology procedures during a 2-month period in our institution were studied. Demographic details, nature of procedure, FST and PSD were measured. The FST to PSD ratio was calculated and compared between patient and procedural factors. RESULTS 67 procedures on patients (23 female) with body mass index (BMI) of 28 (SD 5) Kg/m2 were studied. Screening times ranged from 0.2 to 96.6 min (median 11.2). PSD ranged from <0.1 to 1108 mGy (median 141). There was a positive correlation between PSD to FST ratio and BMI (r = 0.59, p < 0.001). The PSD to FST ratio was higher in cardiac resynchronization therapy (CRT) devices than single or dual chamber ICDs (p = 0.002). CONCLUSION FST is not a reliable predictor of deterministic skin injury and in high-risk procedures such as CRT devices and those on individuals of high BMI PSD should be measured.
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Affiliation(s)
- J R Paisey
- Wessex Cardiothoracic Centre, Southampton University Hospitals, UK.
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Jongbloed MRM, Bax JJ, Lamb HJ, Dirksen MS, Zeppenfeld K, van der Wall EE, de Roos A, Schalij MJ. Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: a head-to-head comparison. J Am Coll Cardiol 2005; 45:343-50. [PMID: 15680710 DOI: 10.1016/j.jacc.2004.10.040] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 09/20/2004] [Accepted: 10/04/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to perform a head-to-head comparison between multislice computed tomography (MSCT) and intracardiac echocardiography (ICE). BACKGROUND Different imaging techniques have been used to visualize the pulmonary veins (PV) before radiofrequency ablation of atrial fibrillation. METHODS The PV and their atrial insertion were evaluated in 42 patients (35 men, 49 +/- 9 years) admitted for ablation of PV ostia. Ostia were measured in two directions (anterior-posterior and superior-inferior) with MSCT. Two-dimensional (2-D) measurements of PV ostia were performed with ICE. Results were compared, considering MSCT as the gold standard. Venous ostium indexes were calculated by dividing MSCT measurements in the anterior-posterior direction and the superior-inferior direction. RESULTS Common ostia of left PV were observed in 33 (79%) patients with MSCT and 31 (74%) patients with ICE. Common ostia of right PV were observed in 13 (31%) and 16 (38%) patients, respectively. Additional PV were observed in 13 (31%) patients with MSCT and in 7 (17%) patients with ICE. Ostial diameters by MSCT in the anterior-posterior direction were similar to 2-D measurements by ICE. By contrast, diameters by MSCT in the superior-inferior direction were significantly larger than 2-D diameters measured with ICE. Venous ostium indexes were 0.77 +/- 0.18 and 0.90 +/- 0.15 (p < 0.01) for left and right PV respectively, indicating an oval shape of particularly left PV ostia. CONCLUSIONS Variation in PV anatomy is frequently observed with both techniques. The sensitivity for detection of additional branches is higher for MSCT. Results of measurements of PV ostia suggest an underestimation of ostial size by ICE. Three-dimensional imaging techniques, such as MSCT, are required to demonstrate an oval shape of PV ostia.
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Affiliation(s)
- Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Rotter M, Takahashi Y, Sanders P, Haïssaguerre M, Jaïs P, Hsu LF, Sacher F, Pasquié JL, Clementy J, Hocini M. Reduction of fluoroscopy exposure and procedure duration during ablation of atrial fibrillation using a novel anatomical navigation system†. Eur Heart J 2005; 26:1415-21. [PMID: 15741228 DOI: 10.1093/eurheartj/ehi172] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Catheter ablation of atrial fibrillation (AF) is centred on pulmonary vein (PV) ablation with or without additional atrial substrate modification. These procedures may be prolonged with significant fluoroscopy exposure. This study evaluates a new non-fluoroscopic navigation system during ablation of AF. METHODS AND RESULTS Seventy-two patients undergoing catheter ablation of symptomatic drug refractory AF were prospectively randomized to ablation with (n=35; study group) or without (n=37; control group) non-fluoroscopic navigation. PV isolation was performed in all patients. In patients with persistent or inducible sustained AF after PV isolation linear ablation was performed by joining the superior PVs. PV isolation was achieved in all patients; fluoroscopy (15.4+/-3.4 vs. 21.3+/-6.4 min; P<0.001) and procedural (52+/-12 vs. 61+/-17 min; P=0.02) durations were significantly reduced in the study group. Linear block was achieved in 37 of the 39 patients; with a significant reduction in fluoroscopy (5.6+/-2.2 vs. 9.9+/-4.8 min; P=0.003) and procedural (14.7+/-5.5 vs. 26.6+/-16.9 min; P=0.007) durations in the study group. After a follow-up of 6.9+/-2.9 months (range 3-10), 26 (74%) patients in the non-fluoroscopic navigation group and 29 (78%) patients in the control group were arrhythmia-free after the first procedure. CONCLUSION This prospectively randomized study demonstrates significant reduction of fluoroscopy exposure and procedural duration using supplementary non-fluoroscopic imaging system for AF ablation.
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Affiliation(s)
- Martin Rotter
- Hôpital Cardiologique du Haut-Lévêque, and Université Victor Segalen Bordeaux 2, Bordeaux, France
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Abstract
Recent advancements in our understanding of atrial fibrillation have led to the development of catheter ablation techniques that feasibly could achieve a cure for AF.
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Verbeet T, Castro J, Morissens M, Ngoc ET, Decoodt P. Use of a New Non-Fluoroscopic Three-Dimensional Mapping System in Type I Atrial Flutter Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28 Suppl 1:S99-101. [PMID: 15683538 DOI: 10.1111/j.1540-8159.2005.00074.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We studied 40 patients who underwent cavo-tricuspid isthmus ablation for typical counterclockwise atrial flutter with cooled tip catheters between 2001 and 2003. Complete bi-directional isthmus block was created in all patients. A new, three-dimensional (3D), non-fluoroscopic mapping system was used in 20 patients (test group), and conventional fluoroscopy in 20 others (conventional group), using anatomic and electrophysiologic criteria in both groups. We measured the total procedure, ablation procedure, and overall fluoroscopy times, and the total number of radiofrequency (RF) applications delivered in the two groups. The overall fluoroscopy time was shorter in the test group (mean 8.8 minutes, range 2-17 minutes) than the conventional group (29.7 minutes, range 12-57 minutes; P < 0.001). Though the overall procedure time was similar in both groups (92.5 +/- 28.6 minutes vs 106.5 +/- 20.9 minutes; P = 0.067) the ablation duration (25.1 +/- 6.6 minutes versus 43.3 +/- 19.6 minutes; P = 0.0051) and the total RF applications (10.6 +/- 9.4 versus 16.4 +/- 9.4; P = 0.044) were smaller in the test group. The use of a new, 3D non-fluoroscopic mapping system markedly reduced the fluoroscopy exposure during typical atrial flutter ablation. It was also associated with a significant reduction in ablation time and in the number of RF applications. Since atrial flutter ablation is one of the most frequently performed procedures, this system may significantly reduce the overall amount of radiation exposure in high-volume laboratories.
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Takahashi Y, Rotter M, Sanders P, Jaïs P, Hocini M, Hsu LF, Pasquié JL, Sacher F, Garrigue S, Clémenty J, Haïssaguerre M. Left Atrial Linear Ablation to Modify the Substrate of Atrial Fibrillation Using a New Nonfluoroscopic Imaging System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28 Suppl 1:S90-3. [PMID: 15683536 DOI: 10.1111/j.1540-8159.2005.00036.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Linear left atrial ablation is performed in combination with pulmonary vein (PV) isolation to improve the clinical results of atrial fibrillation (AF) ablation. These procedures require long procedures and fluoroscopic exposure. The aim of the present study was to evaluate the performance of a new, nonfluoroscopic, real-time, three-dimensional navigation system for linear ablation at the left atrial roof and mitral isthmus. The study included 44 patients (54 +/- 10 years of age, 5 women) with drug-refractory AF, who underwent roof line or mitral isthmus linear ablation after 4-PV isolation. In 22 patients, ablation was performed with the navigation system (test group), and in the remainders linear ablation was performed with fluoroscopic guidance alone (control group). Conduction block was achieved in 20 patients (91%) in test group, and 21 patients (95%) in the control group (ns). Use of the navigation system was associated with a shorter fluoroscopic exposure for roof line (5.6 +/- 3.0 minutes vs 8.7 +/- 5.0 minutes, P < 0.05), and a trend for mitral isthmus ablation (7.8 +/- 7.8 minutes vs 12.1 +/- 5.9 minutes). It was also associated with a trend toward shorter procedure times for roof line (15.3 +/- 8.6 minutes vs 22.9 +/- 16.8 minutes) and mitral isthmus line (20.2 +/- 15.8 minutes vs 32.0 +/- 7.6 minutes) but no difference in duration of radiofrequency delivery. There was no procedural complication. The use of this new nonfluoroscopic imaging system was associated with a shorter fluoroscopic exposure as well as a trend toward shorter duration of linear ablation procedures for AF.
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Affiliation(s)
- Yoshihide Takahashi
- Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux 2, Bordeaux, France.
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Becker R, Schoels W. Ablation of atrial fibrillation: Energy sources and navigation tools: A review. J Electrocardiol 2004; 37 Suppl:55-62. [PMID: 15534801 DOI: 10.1016/j.jelectrocard.2004.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ruediger Becker
- University of Heidelberg/Cardiology, Bergheimer, Heidelberg, Germany.
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Ablación de taquicardias ventriculares guiada mediante sistema LocaLisa en pacientes con cardiopatía estructural. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77184-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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