Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program
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Three-dimensional electroanatomic mapping (EAM) systems reduce radiation exposure when radio frequency catheter ablation (RFCA) procedures are performed by well-trained senior operators. Given the steep learning curve associated with complex RFCA, trainees and their mentors must rely on multiple imaging modalities to maximize safety and success, which might increase procedure and fluoroscopy times. The objective of the present study is to determine if 3-D EAM (CARTO and ESI-NavX) improves procedural outcomes (fluoroscopy time, radio frequency time, procedure duration, complication, and success rates) during CA procedures as compared to fluoroscopically guided conventional mapping alone in an academic teaching hospital.
We analyzed a total of 1070 consecutive RFCA procedures over an 8-year period for fluoroscopic time stratified by ablation target and mapping system. Multivariate logistic regression and adjusted odds ratios were calculated for each variable.
No statistically significant differences in acute success rates were noted between conventional and 3-D mapping cases [CARTO (p = 0.68) or ESI-NavX (p = 0.20)]. Moreover, complication rates were also not significantly different between CARTO (p = 0.23) and ESI-NavX (p = 0.53) when compared to conventional mapping. Procedure, radio frequency, and fluoroscopy times were significantly longer with CARTO and ESI-NavX versus conventional mapping [fluoroscopy time: CARTO, 28.3 min; ESI, 28.5 min; and conventional, 24.3 min; p < 0.001)].
The use of 3-D EAM systems during teaching cases significantly increases radiation exposure when compared with conventional mapping. These findings suggest a need to develop alternative training strategies that enhance confidence and safety during catheter manipulation and allow for reduced fluoroscopy and procedure times during RFCA.
KeywordsRadio frequency ablation Tridimensional mapping Conventional mapping Fluoroscopy time Teaching program
Analysis of variance
Adjusted odds ratios
Atrial tachycardia atrioventricular nodal reentry tachycardia
Radio frequency catheter ablation
Compliance of ethical standards
Conflict of interest
Dr. Andrew Krumerman is consultant for Biosense Inc., Biotronik Inc., and Speak2mdbyphone.com.
- 6.Casella, M., Pelargonio, G., Dello Russo, A., Riva, S., Bartoletti, S., Santangeli, P., et al. (2011). “Near-zero” fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX mapping system: personal experience and review of the literature. Journal of Interventional Cardiac Electrophysiology, 31(2), 109–118.CrossRefPubMedGoogle Scholar
- 15.Coggins, D. L., Lee, R. J., Sweeney, J., Chein, W. W., Van Hare, G., Epstein, L., et al. (1994). Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. Journal of the American College of Cardiology, 23(6), 1333–1341.CrossRefPubMedGoogle Scholar
- 18.Razminia, M., Manankil, M. F., Eryazici, P. L., Arrieta-Garcia, C., Wang, T., D’Silva, O. J., et al. (2012). Nonfluoroscopic catheter ablation of cardiac arrhythmias in adults: feasibility, safety, and efficacy. Journal of Cardiovascular Electrophysiology, 23(10), 1078–1086.CrossRefPubMedGoogle Scholar
- 19.Gellis, L. A., Ceresnak, S. R., Gates, G. J., Nappo, L., & Pass, R. H. (2013). Reducing patient radiation dosage during pediatric SVT ablations using an “ALARA” radiation reduction protocol in the modern fluoroscopic era. Pacing and Clinical Electrophysiology, 36(6), 688–694.CrossRefPubMedGoogle Scholar
- 22.Ullah, W., Hunter, R. J., Baker, V., Dhinoja, M. B., Sporton, S., Earley, M. J., et al. (2014). Target indices for clinical ablation in atrial fibrillation: insights from contact force, electrogram, and biophysical parameter analysis. Circulation. Arrhythmia and Electrophysiology, 7(1), 63–68.CrossRefPubMedGoogle Scholar
- 24.Ferguson, J. D., Helms, A., Mangrum, J. M., Mahapatra, S., Mason, P., Bilchick, K., et al. (2009). Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circulation. Arrhythmia and Electrophysiology, 2(6), 611–619.PubMedCentralCrossRefPubMedGoogle Scholar
- 26.Di Biase, L., Paoletti Perini, A., Mohanty, P., Goldenberg, A. S., Grifoni, G., Santangeli, P., et al. (2014). Visual, tactile, and contact force feedback: which one is more important for catheter ablation? Results from an in vitro experimental study. Heart Rhythm, 11(3), 506–513.CrossRefPubMedGoogle Scholar
- 28.De Ponti, R., Marazzi, R., Doni, L. A., Tamborini, C., Ghiringhelli, S., & Salerno-Uriarte, J. A. (2012). Simulator training reduces radiation exposure and improves trainees’ performance in placing electrophysiologic catheters during patient-based procedures. Heart Rhythm, 9(8), 1280–1285.CrossRefPubMedGoogle Scholar
- 29.De Ponti, R., Marazzi, R., Ghiringhelli, S., Salerno-Uriarte, J. A., Calkins, H., & Cheng, A. (2011). Superiority of simulator-based training compared with conventional training methodologies in the performance of transseptal catheterization. Journal of the American College of Cardiology, 58(4), 359–363.CrossRefPubMedGoogle Scholar