Impact of integration of multislice computed tomography imaging into three-dimensional electroanatomic mapping on clinical outcomes, safety, and efficacy using radiofrequency ablation for atrial fibrillation.

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.