507 Is There Utility in Using NAVX With Arctic Front Cryothermal Ablation?

Abstract

John Flynn Private Hospital have been performing Arctic Front cryothermal ablation for atrial fibrillation since 2008, performing 428 cases in this time. In 2019 we started utilising Abbott Navx 3D mapping system to complement the existing procedure. 21 patients underwent pulmonary vein isolation. Patients were given a general anaesthetic. A single transseptal puncture was undertaken with TOE guidance and heparin administered as per protocol. A voltage map of the pulmonary veins was obtained using the Achieve spiral catheter. Balloon is inflated and positioned in all veins and cryothermal ablation is applied once. The Achieve spiral catheter was reinserted and a voltage map made looking at formation of the lesion, if the lesion lacked uniformity a second cryothermal application was undertaken. This was repeated in veins that required further applications. Pulmonary vein isolation was achieved in 63% of the veins after one application of cryothermal energy. At the completion of cases, and after limited additional cryothermal applications, 100% of pulmonary veins were isolated. Advantages of using a 3D mapping system were: when isolation was not achieved with the first freeze it indicated the area needing to be targeted. This can reveal small gaps in the lesion, provide greater understanding of far field signals present, and facilitate better navigation around difficult anatomy of pulmonary vein sets. Using the 3D mapping system did not significantly increase procedure time and radiation exposure was low. The only cost increase was the NAVX patches, which under recent funding changes in Australia are now significantly more cost-effective.