title: Efforts to enhance catheter stability improve atrial fibrillation ablation outcome.
abstract: BACKGROUND
  Contemporary techniques to enhance anatomical detail and catheter contact during atrial fibrillation (AF) ablation include (1) the integration of preacquired tomographic reconstructions with electroanatomical mapping (3-dimensional image integration [I-EAM]), (2) the use of steerable introducers (SIs), and (3) high-frequency jet ventilation (HFJV).
  
  
  OBJECTIVE
  To prove that using these stabilizing techniques during AF ablation improves 1-year procedural outcome.
  
  
  METHODS
  We studied 300 patients undergoing AF ablation at our institution. Patients were divided into 3 equal treatment groups (100 patients each) on the basis of the tools utilized: (1) group 1: AF ablation performed without I-EAM, SI, or HFJV; (2) group 2: AF ablation performed using I-EAM and SI, but without HFJV; and (3) group 3: AF ablation performed with I-EAM, SI, and HFJV. The primary outcome was freedom from AF 1 year after a single ablation procedure. The burden of both acute and chronic pulmonary vein reconnection was also assessed.
  
  
  RESULTS
  Patients from groups 2 and 3 had significantly more nonparoxysmal AF (17% vs 30% vs 39%; P = .002), larger left atria (4.2 ± 0.8 cm vs 4.4 ± 0.7 cm vs 4.5 ± 0.8 cm; P<.001), and higher body mass index (BMI; 28.5 ± 5.8 kg/m² vs 29.1 ± 4.8 kg/m² vs 31.2 ± 5.4 kg/m²; P<.001). Despite these differences, with adoption of I-EAM, SI, and HFJV we noted a significant improvement in 1-year freedom from AF (52% vs 66% vs 74%; P = .006) as well as fewer acute (1.1 ± 1.2 vs 0.9 ± 1.1 vs 0.6 ± 0.9; P = .03) and chronic (3.5 ± 0.9 vs 3.2 ± 0.9 vs 2.4 ± 1.0; P = .02) pulmonary vein reconnections.
  
  
  CONCLUSIONS
  The incorporation of contemporary tools to enhance anatomical detail and ablation catheter stability significantly improved 1-year freedom from AF after ablation.
authors.affiliation: Cardiovascular Division, Department of Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104 , USA. Mathew.Hutchinson@uphs.upenn.edu
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.forename: Jeff E
authors.initials: JE
authors.lastname: Mandel
authors.forename: Nabil
authors.initials: N
authors.lastname: Elkassabany
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Cooper
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Supple
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D057785:Catheters; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome