Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study.
BACKGROUND
The aim of this prospective randomized study was to compare the routine use of electroanatomic imaging (CARTO) with that of conventional fluoroscopically guided activation mapping (conventional) in an unselected population referred for catheter ablation. We sought to compare the two approaches with respect to procedure outcome and duration, radiation exposure, and cost.


RESULTS
All patients undergoing catheter ablation (with the exception of complete AV nodal ablation) were prospectively randomized to either a CARTO or conventional procedure for mapping and ablation. One hundred two patients were randomized. Acute procedural success was similar with either strategy (CARTO vs conventional 43/47 vs 51/55, P > 0.5), as was procedure duration (144 [58] vs 125 [48] min, P = 0.07 (mean [SD]). CARTO was associated with a substantial reduction in fluoroscopy time (9.3 [7.6] vs 28.8 [19.5] min, P < 0.001) and radiation dose (6.2 [6.1] vs 20.8 [32.7] Gray, P = 0.003). CARTO cases used fewer catheters (2.5 [0.7] vs 4.4 [1.1], P < 0.001), but catheter costs were higher (13.8 vs 9.3 units, P < 0.001, where one unit is equivalent to the cost of a nonsteerable quadripolar catheter).


CONCLUSIONS
For all catheter ablation procedures, even when a center's "learning curve" for CARTO is included, procedure duration and outcome are similar for CARTO and conventional procedures. CARTO is associated with drastically reduced fluoroscopy time and radiation dose. Although fewer catheters are used with CARTO, catheter costs remain higher.
Sporton
Simon C
SC
Department of Cardiology, Bart's and The London NHS Trust, London, United Kingdom.
Earley
Mark J
MJ
Nathan
Anthony W
AW
Schilling
Richard J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000601:surgery; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D011446:Prospective Studies; D011829:Radiation Dosage; D013617:Tachycardia, Supraventricular / Q000601:surgery; D017180:Tachycardia, Ventricular / Q000601:surgery; D016896:Treatment Outcome; D014927:Wolff-Parkinson-White Syndrome / Q000601:surgery