Efforts to Enhance Catheter Stability Improve Atrial Fibrillation Ablation Outcome.
BACKGROUND: Contemporary techniques to enhance anatomical detail and catheter contact during atrial fibrillation ablation include: 1) the integration of pre-acquired tomographic reconstructions with electroanatomical mapping (I-EAM); 2) the use streerable introducers (SI); and 3) high frequency jet ventilation (HFJV). OBJECTIVE: We hypothesized that using these stabilizing techniques during AF ablation would improve 1-year procedural outcome. METHODS: We studied 300 patients undergoing AF ablation at our institution. Patients were assigned to three equal treatment groups (100 patients each) based upon the tools utilized: 1) Group 1- AF ablation performed without I-EAM, SI or HFJV; 2) Group 2- AF ablation performed using I-EAM and SI, but without HFJV; and 3) Group 3- AF ablation performed with I-EAM, SI, and HFJV. The primary outcome was freedom from AF 1-year after a single ablation procedure. The burden of both acute and chronic PV reconnection was also assessed. RESULTS: Patients from Groups 2 and 3 had significantly more non-paroxysmal AF (17% vs. 30% vs. 39%, p=0.002), larger left atria (4.2±0.8 vs. 4.4±0.7 vs. 4.5±0.8 cm, p<0.001), and higher BMI (28.5±5.8 vs. 29.1±4.8 vs. 31.2±5.4, p<0.001). Despite these differences, with adoption of I-EAM, SI, and HFJV we noted a significant improvement in 1-year freedom from AF (52% vs. 66% vs. 74%; p=0.006) as well as fewer acute (1.1±1.2 vs. 0.9±1.1 vs. 0.6±0.9, p=0.03) and chronic (3.5±0.9 vs. 3.2±0.9 vs. 2.4±1.0, p=0.02) PV reconnections. CONCLUSIONS: The incorporation of contemporary tools to enhance anatomical detail and ablation catheter stability significantly improved 1-year freedom from AF after ablation.
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