A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation: comparative analysis of two electroanatomical mapping systems.

BACKGROUND

Electroanatomical mapping systems have reduced the amount of fluoroscopy required to ablate the cavotricuspid isthmus. The aims of this study are to evaluate the feasibility and safety of a zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system (Biosense Webster, Diamond Bar, CA, USA) and to compare the results of this approach with those of the zero-fluoroscopy approach using the Ensite-NavX™ system (St. Jude Medical, St. Paul, MN, USA).

METHODS

Twenty consecutive procedures guided by the Carto®3 system (Group A) were compared with two case-control groups matched from 146 procedures guided with the Ensite-NavX™ system. Group B consisted of 20 matched procedures from the first 50 procedures performed in the electrophysiology unit, and Group C consisted of 20 matched procedures from the last 50 procedures. Acute success (bidirectional block), complications, and recurrences were analyzed. The procedure times were also compared.

RESULTS

There were no differences in the rates of acute success (95%, 100%, and 100%, respectively), complications (0%, 5%, and 0%), and recurrences (5.2%, 0%, and 5%) in the three groups. A zero-fluoroscopy approach was attempted in all procedures, and electroanatomical mapping made it possible to successfully avoid fluoroscopy in 90% of the procedures in Group A, 85% in B, and 95% in C. The total procedure time was shorter in Group C. The fluoroscopy and radiofrequency times were not different.

CONCLUSIONS

A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system is feasible in most procedures. This approach has similar results to the zero-fluoroscopy approach using the Ensite-NavX™ system.