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Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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)].

Conclusions

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.

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Abbreviations

AF:

Atrial fibrillation

AFL:

Atrial flutter

ANOVA:

Analysis of variance

AOR:

Adjusted odds ratios

AVNRT:

Atrial tachycardia atrioventricular nodal reentry tachycardia

AT:

Atrial tachycardia

RFCA:

Radio frequency catheter ablation

IR:

Ionized radiation

WPW:

Wolff-Parkinson-White syndrome

VT:

Ventricular tachycardia

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Author notes

    Authors and Affiliations

    1. Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

      Jorge Romero, Florentino Lupercio, David Goodman-Meza, Juan Carlos Ruiz, David F. Briceno, John D. Fisher, Jay Gross, Kevin Ferrick, Soo Kim, Luigi Di Biase, Mario J. Garcia & Andrew Krumerman

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    1. Jorge Romero
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    Correspondence to Andrew Krumerman.

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    Dr. Andrew Krumerman is consultant for Biosense Inc., Biotronik Inc., and Speak2mdbyphone.com.

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    Jorge Romero and Florentino Lupercio contributed equally to this work.

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    Romero, J., Lupercio, F., Goodman-Meza, D. et al. Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program. J Interv Card Electrophysiol 45, 71–80 (2016). https://doi.org/10.1007/s10840-015-0073-6

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    • DOI: https://doi.org/10.1007/s10840-015-0073-6

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