title: Steerable sheath catheter navigation for ablation of atrial fibrillation: a case-control study.
abstract: 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%.
authors.affiliation: University of Leipzig, Heart Center, Leipzig, Germany. cp7026@yahoo.de
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Hans
authors.initials: H
authors.lastname: Kottkamp
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Nicos
authors.initials: N
authors.lastname: Dagres
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.forename: Sam
authors.initials: S
authors.lastname: Riahi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Weiss
authors.forename: Simon
authors.initials: S
authors.lastname: Kircher
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
mesh_terms: 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