Document Detail


Remote-controlled magnetic pulmonary vein isolation using a new three-dimensional non-fluoroscopic navigation system: A single-centre prospective study.
MedLine Citation:
PMID:  23906679     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Catheter ablation of atrial fibrillation (AF) focuses on pulmonary vein isolation (PVI), but the procedure is associated with significant X-ray exposure. Few data exist concerning the combination of remote magnetic navigation (RMN) and a new three-dimensional non-fluoroscopic navigation system (Carto(®) 3), which facilitates precise catheter navigation and limits X-ray exposure.
AIMS: To assess the efficacy and extent of fluoroscopic exposure associated with the combination of RMN and the Carto 3 system in patients requiring AF ablation.
METHODS: Between January and September 2011, catheter ablation was performed remotely using the Carto 3 system in 81 consecutive patients who underwent PVI for symptomatic drug-refractory AF. The radiofrequency generator was set to a fixed power≤35W. The primary endpoint was wide-area circumferential PVI confirmed by spiral catheter recording during ablation and including additional lesion lines (left atrial roof and coronary sinus defragmentation) or complex fractionated atrial electrograms for persistent AF. Secondary endpoints included procedural data, complications and freedom from atrial tachycardia (AT)/AF.
RESULTS: Mean age was 60±9years; 20% were women; 73% had symptomatic paroxysmal AF; 27% had persistent AF. The CHA2DS2-VASc score was 1.2±1. Median procedure time was 3.5±1hours; median total X-ray exposure time was 13±7minutes; transseptal puncture and catheter positioning took 8±4minutes, left atrium electroanatomical reconstruction 1±4minutes and catheter ablation 3.5±5minutes. Recurrences were AT (n=3; 3.7%), paroxysmal AF (n=8; 9.9%) and persistent AF (n=4; 4.9%); redo ablation was performed in these 15 (19%) patients. After a median follow-up of 15±6months and a single procedure, 71% of patients were free of symptoms; 84% remained asymptomatic after two procedures.
CONCLUSIONS: RMN with irrigated catheters combined with the Carto 3 system can be effectively performed in patients requiring AF ablation with minimal use of fluoroscopy, but larger randomized studies are warranted.
Authors:
Antoine Da Costa; Mouna Ben H'dech; Cécile Romeyer-Bouchard; Laurence Bisch; Alexis Gate-Martinet; Marie Levallois; Karl Isaaz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-29
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  -     ISSN:  1875-2128     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-8-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Affiliation:
Service de Cardiologie, Hôpital Nord, CHU de Saint-Étienne, Université Jean-Monnet, 42055 Saint-Étienne Cedex 2, France. Electronic address: dakosta@aol.com.
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