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Effect of Non-fluoroscopic Catheter Tracking on Radiation Exposure during Pulmonary Vein Isolation: Comparison of 4 ablation systems.

Background: A novel non-fluoroscopic catheter tracking system (Mediguide) can be used in combination with a 3D mapping system for atrial fibrillation (AF) ablation. However, the benefit on radiation exposure of the Mediguide system compared to other ablation systems is unknown. Methods: We retrospectively enrolled consecutive 73 patients (51 men; 59±11 years; 60 paroxysmal AF) undergoing pulmonary vein isolation by the same operator. Radiation time, radiation effective dose, procedure time, AF recurrence after ablation, and procedure-related complications were compared among 4 different ablation systems. Results: Mediguide was used in 16 patients (group A), CARTO™ in 17 (group B), Cryoballoon in 30 (group C), and Multi-electrode Pulmonary Vein Ablation Catheter (PVAC) in 10 (group D). Although procedure time was shorter in patients with Cryoballoon (median 110 [interquartile range 99-120] min) and PVAC (123 [112–146] min) compared to those with Mediguide (181 [168–214] min) and CARTO (179 [160–195] min) (P<0.001), radiation exposure time and effective dose were decreased in patients with Mediguide compared to the other ablation systems (A: 5 [3–6] min; B: 14 [11–16] min; C: 14 [11–18] min; D: 20 [16–24] min, P<0.001 and A: 1.1 [0.8–2.0] mSv; B: 2.5 [1.3–3.8] mSv; C: 2.0 [1.4–2.5] mSv; D: 1.7 [1.4–3.6] mSv, P=0.015, respectively). AF recurrence rates and procedure-related complications were comparable among the 4 groups. Conclusions: The Mediguide system reduces radiation exposure compared to other ablation systems without increasing AF recurrence or procedure-related complications.

Credits: Yoshihisa Naruse, MD, PhD1; Fehmi Kee, MD1; Marta de Riva, MD1; Masaya Watanabe, MD, PhD1; Adrianus P. Wijnmaalen, MD, PhD1; Reza Alizadeh Dehnavi, MD, PhD1; Martin J Schalij, MD, PhD1; Katja Zeppenfeld, MD, PhD1; Serge A. Trines, MD, PhD1.

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