Background: Catheter ablation for treatment of AF is associated with significant fluoroscopy exposure. Recently, a novel sensor-based electromagnetic catheter tracking system (MediGuide [MG] Positioning System) was introduced. We prospectively evaluated the impact of the MG system on fluoroscopy times during pulmonary vein isolation (PVI) procedures for paroxysmal AF.
Methods: The MG system was recently installed in 1 of our 3 EP labs. A prospective registry evaluating fluoroscopy duration and radiation exposure was initiated in February 2013, which includes all AF ablation procedures with or without MG, using irrigated radiofrequency (RF) energy. To assess the impact of MG on fluoroscopy times, we classified the procedure into the following steps: 1) positioning of CS catheter, 2) transseptal access, 3) creation of left atrial geometry, 4) PVI. For patients undergoing procedures with MG, fluoroscopy cineloop acquisition was performed in PA and LAO views at the beginning of the intervention, which were then used for non-fluoroscopic catheter tracking and positioning of CS and ablation catheters. In all patients, a circular mapping catheter and 3D mapping system was used and the procedural endpoint was defined as electrical PVI.
Results: During the first 2 months of the registry, 14 patients undergoing AF ablation procedures were included, 7 with and 7 without MG. The mean age was 60.5±9.3 years and 71% were male. Electrical PVI was successfully achieved in all procedures and no complications were observed. The mean procedural duration was 138.1±17.4 min with MG vs 131.7±46.2 min without MG (p=0.09). The mean RF delivery time was 50.7±20.7 min with MG vs 39.3±14.7 min without MG (p=0.74). Details of fluoroscopy duration and radiation exposure are summarized in the Table.
Conclusions: Initial results using a novel non-fluoroscopic catheter tracking system for PVI procedures in patients with AF indicate a significant reduction (i.e., 48%) in the total fluoroscopy duration. The ongoing prospective registry should better define the procedural steps associated with the greatest reduction in fluoroscopy exposure.