title: A randomised comparison of Cartomerge vs. NavX fusion in the catheter ablation of atrial fibrillation: the CAVERN Trial.
abstract: OBJECTIVE
  Integration of a 3D reconstruction of the left atrium into cardiac mapping systems can aid catheter ablation of atrial fibrillation (AF). The two most widely used systems are NavX Fusion and Cartomerge. We aimed to compare the clinical efficacy of these systems in a randomised trial.
  
  
  METHODS
  Patients undergoing their first ablation were randomised to mapping using either NavX fusion or CartoMerge. Pulmonary vein isolation by wide area circumferential ablation was performed for paroxysmal AF with additional linear and fractionated potential ablation for persistent AF. Seven-day Holter monitoring was used for confirmation of sinus rhythm maintenance at 6 months.
  
  
  RESULTS
  Ninety-seven patients were randomised and underwent a procedure. There was no difference in the primary endpoint of freedom from arrhythmia at 6 months (51% in the Cartomerge group vs. 48% in the NavX Fusion group, p = 0.76). 3D image registration was faster with Cartomerge (24 vs. 33 min, p = 0.0001), used less fluoroscopic screening (11 vs. 15 min, p = 0.039) with a lower fluoroscopic dose (840 vs. 1,415 mGyCm(2), p = 0.043). There was a strong trend to lower ablation times in the Cartomerge group, overall RF time (3,292 s vs. 4,041, p = 0.07). Distance from 3D lesion to 3D image shell was smaller in the Cartomerge group (2.7 ± 1.9 vs. 3.3 ± 3.7 mm, p < 0.001).
  
  
  CONCLUSIONS
  Cartomerge appears to be faster and uses less fluoroscopy to achieve registration than NavX Fusion, but overall procedural times and clinical outcomes are similar.
authors: Cardiology Research Department, Barts and the London NHS Trust and University College London, St Bartholomew's Hospital, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London, EC1A 7BE, UK.
authors: Malcolm C
authors: MC
authors: Finlay
authors: Ross J
authors: RJ
authors: Hunter
authors: Victoria
authors: V
authors: Baker
authors: Laura
authors: L
authors: Richmond
authors: Farai
authors: F
authors: Goromonzi
authors: Glyn
authors: G
authors: Thomas
authors: Kim
authors: K
authors: Rajappan
authors: Edward
authors: E
authors: Duncan
authors: Muzahir
authors: M
authors: Tayebjee
authors: Mehul
authors: M
authors: Dhinoja
authors: Simon
authors: S
authors: Sporton
authors: Mark J
authors: MJ
authors: Earley
authors: Richard J
authors: RJ
authors: Schilling
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome