Is it possible to perform a linear lesion with no local electrograms using a three-dimensional mapping system for the ablation of typical atrial flutter?
OBJECTIVE
A randomized prospective study to evaluate the efficacy, safety and long-term outcomes of the complete disappearance of local electrograms along the linear lesion using the EnSite NavX three-dimensional mapping system compared to the conventional fluoroscopy-based mapping for the ablation of typical atrial flutter (AFL).


METHODS
83 patients with spontaneous AFL episodes were randomized to the conventional procedure (group I, 41 patients) or to the EnSite NavX three-dimensional mapping system (group II, 42 patients). When bidirectional block was achieved, a renavigation of the ablation line was performed to verify the absence of local potentials along the line.


RESULTS
In all patients, bidirectional isthmus block was achieved. Total mean fluoroscopy time was 19.8 +/- 4.1 min and 9.1 +/- 3.5 min (p < 0.001) and radiofrequency (RF) mean fluoroscopy time was 6.9 +/- 1.4 min and 0.6 +/- 0.3 min (p < 0.001), respectively, in group I and II. During long-term follow-up of 16 +/- 9 months, there were 4 (10%) AFL recurrences in group I and 0 in group II (p < 0.005).


CONCLUSIONS
NavX accurately renavigates the lesion line and verifies local potentials. The electro-anatomic activation map accurately identifies gaps in the RF lesion line and no recurrences were found compared with 10% recurrences after standard procedures for typical AFL.
Muto
Carmine
C
Department of Cardiology, S.M. Loreto Nuovo, Naples, Italy.
Ottaviano
Luca
L
Canciello
Michelangelo
M
Carreras
Giovanni
G
Angelini
Salvatore
S
Tuccillo
Bernardino
B
D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis / Q000628:therapy*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome