title: A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation: comparative analysis of two electroanatomical mapping systems.
abstract: BACKGROUND
  Electroanatomical mapping systems have reduced the amount of fluoroscopy required to ablate the cavotricuspid isthmus. The aims of this study are to evaluate the feasibility and safety of a zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system (Biosense Webster, Diamond Bar, CA, USA) and to compare the results of this approach with those of the zero-fluoroscopy approach using the Ensite-NavX™ system (St. Jude Medical, St. Paul, MN, USA).
  
  
  METHODS
  Twenty consecutive procedures guided by the Carto®3 system (Group A) were compared with two case-control groups matched from 146 procedures guided with the Ensite-NavX™ system. Group B consisted of 20 matched procedures from the first 50 procedures performed in the electrophysiology unit, and Group C consisted of 20 matched procedures from the last 50 procedures. Acute success (bidirectional block), complications, and recurrences were analyzed. The procedure times were also compared.
  
  
  RESULTS
  There were no differences in the rates of acute success (95%, 100%, and 100%, respectively), complications (0%, 5%, and 0%), and recurrences (5.2%, 0%, and 5%) in the three groups. A zero-fluoroscopy approach was attempted in all procedures, and electroanatomical mapping made it possible to successfully avoid fluoroscopy in 90% of the procedures in Group A, 85% in B, and 95% in C. The total procedure time was shorter in Group C. The fluoroscopy and radiofrequency times were not different.
  
  
  CONCLUSIONS
  A zero-fluoroscopy approach to cavotricuspid isthmus catheter ablation using the Carto®3 system is feasible in most procedures. This approach has similar results to the zero-fluoroscopy approach using the Ensite-NavX™ system.
authors.affiliation: Unidad de Arritmias, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Macías
authors.forename: Inés
authors.initials: I
authors.lastname: Uribe
authors.forename: Luis
authors.initials: L
authors.lastname: Tercedor
authors.forename: Juan
authors.initials: J
authors.lastname: Jiménez-Jáimez
authors.forename: Juan
authors.initials: J
authors.lastname: Jiménez
authors.forename: Teresa
authors.initials: T
authors.lastname: Barrio
authors.forename: Miguel
authors.initials: M
authors.lastname: Álvarez
mesh_terms: D001282:Atrial Flutter / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014261:Tricuspid Valve / Q000601:surgery; D014682:Vena Cava, Inferior / Q000601:surgery
keywords: atrial flutter; catheter ablation; electroanatomical mapping; zero-fluoroscopy approach