Use of a non-fluoroscopic catheter navigation system for pulmonary vein isolation.
BACKGROUND
Pulmonary vein (PV) isolation is commonly performed by using separate mapping and ablating catheters. Steering the ablation catheter to the target electrodes on the mapping catheter can be difficult and time consuming under fluoroscopic guidance. We investigated the use of a non-fluoroscopic catheter navigation system to facilitate radiofrequency pulmonary vein isolation.


METHODS
The LocaLisa non-fluoroscopic catheter navigation system was used during PV isolation in 21 patients. Eleven control patients underwent the procedure under fluoroscopic guidance alone. PV isolation was performed by mapping the veins with a 10 or 20 pole circular mapping catheter and ablating at targeted mapping bipoles with a separate ablation catheter.


RESULTS
The electrodes of both catheters were visualized in 3 dimensional virtual space by LocaLisa. There were no clinical differences between the LocaLisa and control patients. During mapping, electrical artifacts were produced on specific mapping electrodes by contact with the ablation catheter. A blinded observer using LocaLisa correctly identified the mapping electrodes being contacted by the ablation catheter in 368 of 398 (92%) of cases. Total fluoroscopic time was reduced in the LocaLisa group (72 +/- 29 minutes) compared to the control group (102 +/- 37 minutes, p = 0.02). There were no differences between the groups in total procedure times, number of lesions given, complications or long term procedural success (all p > 0.45).


CONCLUSIONS
The LocaLisa catheter navigation system accurately identifies the position of an ablation catheter relative to the target electrodes on a circular mapping catheter. The system also significantly reduces total fluoroscopic time for PV isolation.
Wood
Mark A
MA
Virginia Commonwealth University's Medical College of Virginia, Richmond, VA, USA. mwoodmd@pol.net
Christman
Paul J
PJ
Shepard
Richard K
RK
Ellenbogen
Kenneth A
KA
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D011667:Pulmonary Veins; D018570:Risk Assessment; D012680:Sensitivity and Specificity