Steerable sheath catheter navigation for ablation of atrial fibrillation: a case-control study.
BACKGROUND
Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath.


RESULTS
In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% (P = 0.009) after a single procedure and 6 months of follow-up. With respect to procedural data no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency (RF) burning time. With the steerable sheath mean procedural RF power (33 +/- 9 vs 41 +/- 4 W; P < 0.0005) and total RF energy delivery (97,498 vs 111,864 J; P < 0.005) were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52% (P < 0.0005). The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early postinterventional arrhythmia recurrences was the only but powerful predictor for long-term ablation success.


CONCLUSIONS
An AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial PV ablation at similar intervention times and similar complication rates. The 6-month success rate after a single LA intervention increased from 56% to 77%.
Piorkowski
Christopher
C
University of Leipzig, Heart Center, Leipzig, Germany. cp7026@yahoo.de
Kottkamp
Hans
H
Gerds-Li
Jin-Hong
JH
Arya
Arash
A
Sommer
Philipp
P
Dagres
Nicos
N
Esato
Masahiro
M
Riahi
Sam
S
Weiss
Sebastian
S
Kircher
Simon
S
Hindricks
Gerhard
G
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome