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Improved Electrogram Attenuation during Ablation of Paroxysmal Atrial Fibrillation with the Hansen Robotic System.
MedLine Citation:
PMID:  22494451     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Robotic catheter ablation aims to improve outcomes after ablation of atrial fibrillation (AF) through improved lesion quality. This study examined electrogram attenuation as a measure of efficacy in response to robotic (ROB) and manual (MAN) ablation. Methods: Patients with paroxysmal AF undergoing ablation as part of an ongoing randomized controlled trial were studied (Clinical Trials Registration NCT01037296). Patients underwent pulmonary vein isolation using NavX (St. Jude Medical, St. Paul, MN, USA). Patients were randomized to MAN or ROB catheter ablation using a 3.5-mm irrigated-tip catheter with standardized ablation settings. Bipolar electrogram voltage was measured at 0, 5, 10, 20, and 30 seconds after ablation onset. Distance from ablation lesion to the left atrial surface on NavX were calculated. Results: Similar ablation energy was delivered in ROB and MAN groups, achieving comparable rates of PV isolation (100% vs 98%). The bipolar voltages of 4,434 electrograms from 303 ablation lesions (146 ROB, 157 MAN) were measured. At 30 seconds, signal attenuation was greater in the ROB group than MAN (mean 65 ± 4% vs 55 ± 4% of baseline voltage, P < 0.01). A total of 2,064 NavX ablation lesions were assessed (906 ROB and 1,158 MAN). ROB lesions were on average 0.52 mm further inside the geometry than MAN (P < 0.0001). Conclusions: Robotic ablation results in greater signal attenuation in man. This is achieved despite manual lesions being closer to the left atrial surface. Catheter stability and constant energy delivery may be key to achieving signal attenuation, rather than increased contact force. (PACE 2012;XX:1-9).
Authors:
Edward R Duncan; Malcolm Finlay; Stephen P Page; Ross Hunter; Farai Goromonzi; Laura Richmond; Victoria Baker; Matthew Ginks; Vivienne Ezzat; Mehul Dhinoja; Mark J Earley; Simon Sporton; Richard J Schilling
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-11
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Affiliation:
Department of Cardiology, Barts and the London NHS Trust, London, United Kingdom.
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