title: Different image integration modalities to guide AF ablation: impact on procedural and fluoroscopy times.
abstract: BACKGROUND
  Different image integration modalities are available for atrial fibrillation (AF) ablation, but their impact on procedural and fluoroscopy times has not been evaluated yet.
  
  
  METHODS
  Sixty patients (mean age 52.2 ± 12.0 years, 48.3% men, 75% paroxysmal AF) undergoing pulmonary vein (PV) encircling with PV disconnection for symptomatic drug-refractory AF were randomized to ablation with CARTO electroanatomical mapping (Biosense Webster, Diamond Bar, CA, USA) integrated with: (1) preprocedural magnetic resonance imaging (MRI; Group 1); (2) intracardiac echocardiography (ICE; Group 2); (3) preprocedural MRI and ICE (Group 3).
  
  
  RESULTS
  PV disconnection was achieved in all patients. Total procedural time (Group 1: 124.7 ± 47.0; Group 2: 112.5 ± 30.4; Group 3: 108.6 ± 34.7 minutes) and total ablation time were similar between groups (P = ns). MRI integration alone required a higher fluoroscopy time (23.8 ± 6.9 in Group 1 vs 11.0 ± 2.3 and 13.9 ± 4.2 minutes in Groups 2 and 3, respectively; P < 0.005) and a longer time spent in the left atrium (109.0 ± 43.5 in Group 1 vs 78.2 ± 29.7 and 74.8 ± 34.3 minutes in Groups 2 and 3, respectively; P = 0.03) in comparison to ICE integration. Addition of MRI to ICE integration showed a tendency for a higher fluoroscopy time in comparison to ICE integration alone (P = 0.06). At a mean follow-up of 9.1 ± 2.2 months, there were no significant differences in AF recurrences among the groups (P = ns).
  
  
  CONCLUSIONS
  ICE image integration significantly reduces the fluoroscopy time and the time spent in the left atrium in comparison to MRI integration alone. Addition of MRI to ICE integration does not reduce total procedural time and seems to lead to higher fluoroscopy time in comparison to ICE integration alone.
authors.affiliation: Chair of Cardiology, S. Anna University Hospital, Ferrara, Italy. ltt@unife.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Pratola
authors.forename: Elisa
authors.initials: E
authors.lastname: Baldo
authors.forename: Paolo
authors.initials: P
authors.lastname: Artale
authors.forename: Lina
authors.initials: L
authors.lastname: Marcantoni
authors.forename: Tiziano
authors.initials: T
authors.lastname: Toselli
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Percoco
authors.forename: Biagio
authors.initials: B
authors.lastname: Sassone
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004453:Echoencephalography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted; D018511:Systems Integration; D013996:Time and Motion Studies; D016896:Treatment Outcome