Impact of preprocedural imaging on outcomes of catheter ablation in patients with atrial fibrillation.

PURPOSE

This study aims to determine the impact of preprocedural imaging using computerized tomography (CT) or magnetic resonance imaging (MRI) with 3-D reconstruction on procedural efficiency, efficacy, complications and clinical outcome in patients who undergo radiofrequency catheter ablation (RFA) to eliminate atrial fibrillation (AF).

METHODS

In this registry, a CT (n = 161) or MRI (n = 37) was obtained prior to RFA in 198 of 333 consecutive patients (age 61 ± 10 years) with paroxysmal (172) or persistent (161) AF. Antral pulmonary vein isolation was performed in all patients using an open-irrigation-tip catheter with a 3-D electroanatomical navigation system. Procedural and clinical outcomes were compared among patients who underwent RFA with and without preprocedural imaging.

RESULTS

The mean duration of the procedure (246 ± 47 vs. 242 ± 40 min, P = 0.55), fluoroscopy (47 ± 13 vs. 50 ± 10 min, P = 0.16), and total RF application (83 ± 27 vs. 78 ± 23 min, P = 0.17) were similar among patients who did and did not have preprocedural imaging. The likelihood of a complication also was similar (5/198 [3%] vs. 4/135 [3%], P = 1.0). A repeat ablation was performed in 95/198 (48%) and 61/135 (45%) of the patients who did and did not have imaging study, respectively (P = 0.62). At 22 ± 9 months, after a mean of 2 ± 1 procedures, 140/198 (71%) and 101/135 (75%) of the patients who did and did not have preprocedural imaging were in sinus rhythm (P = 0.4).

CONCLUSIONS

Preprocedural awareness of pulmonary venous and left atrial anatomy does not appear to have an effect on procedural efficiency or clinical outcomes in patients who undergo catheter ablation for AF.