Visualization of multiple catheters with electroanatomical mapping reduces X-ray exposure during atrial fibrillation ablation

Aims Atrial fibrillation (AF) ablation still requires long procedural time and high radiation exposure with its related risk for the patient and the operators. This study was designed to compare three different approaches of AF ablation to verify the hypothesis that image integration with electroanatomic mapping allows minimal use of fluoroscopy. Therefore, we evaluated the procedure and fluoroscopy times of ablation using three imaging modalities: conventional fluoroscopy, image integration electroanatomic mapping, and a new electroanatomic mapping system that provides visualization of multiple catheters. Methods and results One hundred and twenty patients with symptomatic refractory AF were enrolled in the study. Patients were randomly assigned to fluoroscopy alone (Group A, 40 patients), electroanatomic integration (Cartomerge®, Group B, 40 patients), and electroanatomic integration plus catheters visualization (Carto® 3 System, Group C, 40 patients) guided procedures. The ablation procedure aimed at isolating the pulmonary veins and creating lesion lines at the left atrial roof and left isthmus. Procedure and fluoroscopy parameters were recorded in all patients. Total procedure time and skin to catheter positioning time did not significantly differ between the groups. Total fluoroscopy time was statistically different between all three groups (Group A, 18′09″ ± 5′00″; Group B, 9′48″ ± 3′41″; Group C, 2′28″ ± 1′40″; P< 0.001). A significant difference was noted in ablation fluoroscopy time between all groups (P < 0.001), mainly due to shortened fluoroscopy time in Group B (7′34″ ± 3′15″) and Group C (0′21″ ± 0′31″) when compared with Group A (16′07″ ± 5′04″). Conclusion Image integration and, to a larger extent, visualization of multiple catheters allowed a minimal use of fluoroscopy in transcatheter AF ablation.