title: Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system.
abstract: OBJECTIVE
  Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D catheter tracking system has been introduced integrating 3D non-fluoroscopic catheter navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated.
  
  
  RESULTS
  Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation catheter (IBI, SJM). In all 10 patients both sensor-equipped MG catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures.
  
  
  CONCLUSIONS
  For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation catheter was not yet available for use in the study.
authors.affiliation: Department of Electrophysiology, Heart Center, University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. philipp.sommer@herzzentrum-leipzig.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Wojdyla-Hordynska
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004574:Electromagnetic Fields; D004867:Equipment Design; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome