Image integration increases efficacy of paroxysmal atrial fibrillation catheter ablation: results from the CartoMerge Italian Registry.
OBJECTIVE
The aim of this study was to investigate whether circumferential pulmonary vein (PV) isolation guided by image integration improves the procedural and clinical outcomes of atrial fibrillation (AF) ablation in comparison with segmental PV isolation and circumferential PV isolation guided by three-dimensional (3D) electroanatomical mapping alone.


RESULTS
Procedural and clinical outcomes of 573 patients who underwent their first catheter ablation for paroxysmal AF between January 2005 and April 2007 were collected from 12 centres. We evaluated three techniques: segmental ostial PV isolation (SOCA group, 240 patients), circumferential PV isolation guided by electroanatomical mapping (CARTO group, 107 patients), and circumferential PV isolation guided by electroanatomical mapping integrated with magnetic resonance/computed tomographic images of the left atrium (MERGE group, 226 patients). Procedure duration proved to be shorter in MERGE group patients than in CARTO group patients (P < 0.04), but longer than in SOCA group patients (P < 0.0001). During follow-up, atrial tachyarrhythmias relapsed more frequently in SOCA group patients (44.6%) and CARTO group patients (41.7%) than in MERGE group patients (22.6%; P < 0.0001).


CONCLUSIONS
In patients with paroxysmal AF, circumferential PV isolation guided by image integration significantly improves clinical outcome in comparison with both circumferential PV isolation guided by 3D mapping alone and with segmental electrophysiologically guided PV isolation.
Bertaglia
Emanuele
E
Ospedale Civile di Mirano, Via Mariutto, 13-30035 Mirano, Italy. bertagliaferro@alice.it
Bella
Paolo Della
PD
Tondo
Claudio
C
Proclemer
Alessandro
A
Bottoni
Nicola
N
De Ponti
Roberto
R
Landolina
Maurizio
M
Bongiorni
Maria Grazia
MG
Corò
Leonardo
L
Stabile
Giuseppe
G
Dello Russo
Antonio
A
Verlato
Roberto
R
Mantica
Massimo
M
Zoppo
Franco
F
D001281:Atrial Fibrillation / Q000401:mortality*; D018780:Body Surface Potential Mapping / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000401:mortality*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D013382:Subtraction Technique / Q000706:statistics & numerical data; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D015018:Ytterbium
D015018:Ytterbium