Catheter Ablation of Paroxysmal Atrial Fibrillation Using a 3D Mapping System

Abstract

Background-We treated paroxysmal recurrent atrial fibrillation (AF) with radiofrequency (RF) catheter ablation by creating long linear lesions in the atria. To achieve line continuity, a 3D electroanatomic nonfluoroscopic mapping system was used. Methods and Results-In 27 patients with recurrent AF, a catheter incorporating a passive magnetic field sensor was navigated in both atria to construct a 3D activation map. RF energy was delivered to create continuous linear lesions: 3 lines (intercaval, isthmic, and anteroseptal) in the right atrium and a long line encircling the pulmonary veins in the left atrium. After RF application, the atria were remapped to validate completeness of the block lines, demonstrated by late activation of the areas circumscribed by the lines. The mean procedure duration was 312Ϯ103 minutes (range, 187 to 495), with mean fluoroscopy time of 107Ϯ44 minutes (range, 32 to 185 minutes). No acute complications occurred, but 1 patient experienced early prolonged sinus pauses and received a pacemaker. During the first day, 17 patients (63%) had AF episodes, but at discharge, 25 patients were in sinus rhythm. After a follow-up of 6.0 to 15.3 months (average, 10.5Ϯ3.0 months), 16 patients are asymptomatic, 3 have an almost complete disappearance of symptoms, 1 patient is improved, and 7 patients have their AF attacks unchanged. Conclusions-Paroxysmal recurrent drug-refractory AF can be treated by RF catheter ablation. Creation of long continuous linear lesions necessary to compartmentalize the atria is facilitated by a nonfluoroscopic electroanatomic mapping system. (Circulation. 1999;100:1203-1208.)

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…197,430,431,432,433 Direct catheter ablation of the triggers was limited by the infrequency with which AF initiation could be reproducibly triggered. To overcome these limitations, an ablation approach was introduced 433 that was designed to electrically isolate the PVs.…”

“…434,435 Ablation at these sites was either performed segmentally, guided by a circular mapping catheter 433,436 positioned close to the PV ostium, the so-called segmental PV ablation, or by wider continuous circumferential ablation lesions created to surround the right or left PVs, 244,432 the so-called wide-area circumferential ablation (WACA). The circumferential ablation or isolation line was either guided by 3D EAM, 244,437,438 by fluoroscopy, 439 or by intracardiac echocardiography (ICE).…”

Intracardiac ECHO Integration With Three Dimensional Mapping: Role in AF Ablation

“…Pulmonary vein antrum isolation guided by intracardiac echocardiography (ICE) 1 and circumferential pulmonary vein ablation guided by electroanatomical imaging 2,3 are established therapeutic modalities in patients with atrial fibrillation (AF). While the ICE guided technique affords real time imaging of the cardiac structures and monitoring for complications, this technique does not allow registration of the ablation lesions or other sites of interest during the study.…”

Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach

“…Percutaneous catheter ablation for AF has long procedure times and associated complications such as cardiac tamponade, stroke, and pulmonary vein stenosis. [14][15][16] On the other hand, surgical epicardial ablation has been reported with midterm success rate. 17 However, a full sternotomy used in the epicardial ablation is relatively invasive, whereas the ablation procedure itself is simple.…”