Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study.
OBJECTIVE
Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter.


RESULTS
We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P < 0.001). This resulted in a significant reduction in radiation dose in patients randomized to NFCT [17.4 (IQR 11; 206.6) cGy cm(2)] vs. the CONV group [418.4 (IQR 277; 812.2) cGy cm(2)] (P < 0.001). There were no significant differences in procedure duration between the NFCT group [49.5 (IQR 37; 65) min] when compared with the CONV group [33.5 (IQR 26.3; 55.5) min] (P = 0.053). No adverse events were recorded. Freedom from atrial flutter at 6 months of follow-up was 19/20 (95%) in the NFCT and 18/20 (90%) in the CONV group (n.s.).


CONCLUSIONS
In this first prospective randomized study, by comparing NFCT with standard fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use.
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany schoene_katha@t-online.de.
Katharina
K
Schoene
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Sascha
S
Rolf
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Denis
D
Schloma
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Silke
S
John
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Arash
A
Arya
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Borislav
B
Dinov
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Sergio
S
Richter
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Andreas
A
Bollmann
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Gerhard
G
Hindricks
Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany.
Philipp
P
Sommer
D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis* / Q000601:surgery*; D062906:Cardiac Catheters; D004574:Electromagnetic Fields; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome
Ablation; Non-fluoroscopic tracking system; Radiation time; Typical atrial flutter