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Catheter ablation of atrial fibrillation supported by novel nonfluoroscopic 4D navigation technology

, : Catheter ablation of atrial fibrillation supported by novel nonfluoroscopic 4D navigation technology. Heart Rhythm 10(9): 1293-1300

The MediGuide Technology (MGT) represents a novel sensor-based electromagnetic 4D navigation system allowing real-time catheter tracking in the environment of pre-recorded x-ray loops. We now report on our clinical experience in atrial fibrillation (AF) ablation with recently available MGT-enabled ablation catheters. MGT was used in addition to a conventional 3D mapping system in 80 pts with AF (47 male, age 61 10 yrs., 40 with persistent AF), who underwent circumferential pulmonary vein (PV) isolation, voltage mapping substrate modification. Short native RAO/LAO loops were used as background movies for non-fluoroscopic placement of sensor-equipped diagnostic catheters into the coronary sinus and the right ventricle. After single transseptal puncture, selective angiograms of the pulmonary veins were used as background movies for near nonfluoroscopic left atrial (LA) reconstruction. CT registration as well as mapping/ablation was performed using the new open-irrigated MGT-enabled ablation catheter. MGT application was not associated with a change in established workflow. Large parts of the procedure (mean entire duration 167 47 min) could be done without additional fluoroscopy, whereas median residual fluoroscopy duration of 4.6 (interquartile range: 2.9, 7.1) min was mainly used for the acquisition of background loops, transseptal puncture, occasional verification of transseptal sheath position, and manipulation of the circular mapping catheter. Three (4%) minor complications occurred. MGT easily integrates into the workflow of standard AF ablation and allows for high-quality nonfluoroscopic 4D catheter tracking. This results in very low radiation exposure for patients and staff without complicating the workflow of the procedure.


PMID: 23680898

DOI: 10.1016/j.hrthm.2013.05.008

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