The impact of steerable sheath visualization during catheter ablation for atrial fibrillation.

AIMS Incorporating a steerable sheath that can be visualized using an electroanatomical mapping (EAM) system may allow for more efficient mapping and catheter placement, while reducing radiation exposure, during ablation procedures for atrial fibrillation (AF). This study evaluated fluoroscopy usage and procedure times when a visualizable steerable sheath was used compared with a non-visualizable steerable sheath for catheter ablation for AF. METHODS AND RESULTS In this retrospective, observational, single-centre study, patients underwent catheter ablation for AF using a steerable sheath that is visualizable using the CARTO EAM (VIZIGO; n = 57) or a non-visualizable steerable sheath (n = 34). The acute procedural success rate was 100%, with no acute complications in either group. Use of the visualizable sheath vs. the non-visualizable sheath was associated with a significantly shorter fluoroscopy time [median (first quartile, third quartile), 3.4 (2.1, 5.4) vs. 5.8 (3.8, 8.6) min; P = 0.003], significantly lower fluoroscopy dose [10.0 (5.0, 20.0) vs. 18.5 (12.3, 34.0) mGy; P = 0.015], and significantly lower dose area product [93.0 (48.0, 197.9) vs. 182.2 (124.5, 355.0) μGy·m2; P = 0.017] but with a significantly longer mapping time [12.0 (9.0, 15.0) vs. 9.0 (7.0, 11.0) min; P = 0.004]. There was no significant difference between the visualizable and non-visualizable sheaths in skin-to-skin time [72.0 (60.0, 82.0) vs. 72.0 (55.5, 80.8) min; P = 0.623]. CONCLUSION In this retrospective study, use of a visualizable steerable sheath for catheter ablation of AF significantly reduced radiation exposure vs. a non-visualizable steerable sheath. Although mapping time was longer with the visualizable sheath, the overall procedure time was not increased.

[1]  T. Símor,et al.  Visualizable vs. standard, non-visualizable steerable sheath for pulmonary vein isolation procedures: Randomized, single-centre trial , 2022, Frontiers in Cardiovascular Medicine.

[2]  R. Mandapati,et al.  Post-FDA Approval “Real-World” Safety Profile Between Different Steerable Sheaths During Catheter Ablation: A Food and Drug Administration MAUDE database study , 2022, Heart Rhythm.

[3]  Z. Cen,et al.  Effects of the visualized steerable sheath applied to catheter ablation of paroxysmal atrial fibrillation , 2021, Journal of Interventional Cardiac Electrophysiology.

[4]  Y. Okumura,et al.  Impact of the combined use of intracardiac ultrasound and a steerable sheath visualized by a 3D mapping system on pulmonary vein isolation , 2021, Pacing and clinical electrophysiology : PACE.

[5]  E. Koźluk,et al.  First experience with left atrial arrhythmia ablation using a bi-directional steerable transseptal sheath (Vizigo) visible in the CARTO system as a method to reduce fluoroscopy. , 2020 .

[6]  W. Stevenson,et al.  Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation , 2018, Journal of cardiovascular electrophysiology.

[7]  M. Chung,et al.  2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation , 2017, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[8]  Laura J. Bonnett,et al.  Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[9]  C. Piorkowski,et al.  Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study. , 2015, Heart rhythm.

[10]  D. Lin,et al.  Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation? , 2015, Methodist DeBakey cardiovascular journal.

[11]  E. Piccaluga,et al.  Risks Related To Fluoroscopy Radiation Associated With Electrophysiology Procedures. , 2014, Journal of atrial fibrillation.

[12]  A. Diegeler,et al.  Esophago‐pericardial Fistula Complicating Atrial Fibrillation Ablation Using a Novel Irrigated Radiofrequency Multipolar Ablation Catheter , 2014, Journal of cardiovascular electrophysiology.

[13]  Sanjay Dixit,et al.  Efforts to enhance catheter stability improve atrial fibrillation ablation outcome. , 2013, Heart rhythm.

[14]  P. Neužil,et al.  Catheter ablation of atrial fibrillation without the use of fluoroscopy. , 2010, Heart rhythm.

[15]  A. d'Avila,et al.  Redo Procedures in Patients with Paroxysmal Atrial Fibrillation , 2010 .

[16]  Xingpeng Liu,et al.  Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique , 2005, Circulation.

[17]  Stephen Balter,et al.  Occupational hazards of interventional cardiologists: Prevalence of orthopedic health problems in contemporary practice , 2004, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[18]  P. Tchou,et al.  Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies. , 2002, Journal of the American College of Cardiology.