3D navigation system allows remarkable reduction in fluoroscopy use during cavo-tricuspid isthmus ablation.

Abstract

Typical atrial flutter (AFL) is one of the most common supraventricular arrhythmias. Its treatment mainly relies on cavo-tricuspid isthmus (CTI) ablation, which can be performed either using conventional fluoroscopy, still mainly used, or 3D navigation system to track the position of the catheter. The aim of this study is to show that the use of a 3D navigation system allows a dramatic reduction of fluoroscopy use during CTI ablation, without any loss of efficacy, time, or safety. In this single-center study, we retrospectively compared 134 cases of CTI ablation performed for typical AFL without a 3D navigation system with 95 cases of CTI ablation performed with such a 3D system. We compared the rates of procedural success (defined as obtaining a bidirectional electrical conduction block), freedom from AFL recurrence at 1-year follow-up, procedural time and safety, and fluoroscopy use. Compared to conventional fluoroscopy, the use of a 3D navigation system significantly decreased the duration of fluoroscopy use (2min 13s±2min 16s versus 14min 41s±10min 39s, p< 0.0001) and dose-area products (1567.9 ± 1329.5mGycm2 versus 8263.3 ± 8636.6mGycm2, p< 0.0001). Procedure success rates, duration, and safety were not different between groups. The use of 3D navigation during CTI ablation substantially reduces fluoroscopy use duration, without reducing the success rates and safety or prolonging the procedure duration, as compared to conventional fluoroscopy. We therefore suggest the generalization of this navigation system.