title: Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program.
abstract: BACKGROUND
  Three-dimensional electroanatomic mapping (EAM) systems reduce radiation exposure when radio frequency catheter ablation (RFCA) procedures are performed by well-trained senior operators. Given the steep learning curve associated with complex RFCA, trainees and their mentors must rely on multiple imaging modalities to maximize safety and success, which might increase procedure and fluoroscopy times. The objective of the present study is to determine if 3-D EAM (CARTO and ESI-NavX) improves procedural outcomes (fluoroscopy time, radio frequency time, procedure duration, complication, and success rates) during CA procedures as compared to fluoroscopically guided conventional mapping alone in an academic teaching hospital.
  
  
  METHODS
  We analyzed a total of 1070 consecutive RFCA procedures over an 8-year period for fluoroscopic time stratified by ablation target and mapping system. Multivariate logistic regression and adjusted odds ratios were calculated for each variable.
  
  
  RESULTS
  No statistically significant differences in acute success rates were noted between conventional and 3-D mapping cases [CARTO (p = 0.68) or ESI-NavX (p = 0.20)]. Moreover, complication rates were also not significantly different between CARTO (p = 0.23) and ESI-NavX (p = 0.53) when compared to conventional mapping. Procedure, radio frequency, and fluoroscopy times were significantly longer with CARTO and ESI-NavX versus conventional mapping [fluoroscopy time: CARTO, 28.3 min; ESI, 28.5 min; and conventional, 24.3 min; p < 0.001)].
  
  
  CONCLUSIONS
  The use of 3-D EAM systems during teaching cases significantly increases radiation exposure when compared with conventional mapping. These findings suggest a need to develop alternative training strategies that enhance confidence and safety during catheter manipulation and allow for reduced fluoroscopy and procedure times during RFCA.
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Florentino
authors.initials: F
authors.lastname: Lupercio
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Goodman-Meza
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Ruiz
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Fisher
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Gross
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Ferrick
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Soo
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. akrumerm@montefiore.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Krumerman
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000295:instrumentation* / Q000706:statistics & numerical data; D015897:Comorbidity; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000295:instrumentation; D009519:New York City / Q000453:epidemiology; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011835:Radiation Protection; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Conventional mapping; Fluoroscopy time; Radio frequency ablation; Teaching program; Tridimensional mapping