Differences in success of repeat ablation procedure for recurrent atrial fibrillation after two different ablation strategies: Results from a prospective randomized study comparing pulmonary vein isolation versus circumferential pulmonary vein ablation

Abstract

Minnesota.) non-fluoroscopic mapping system has the potential to reduce X-ray exposure during electrophysiological procedures. This is the first prospective randomised controlled study to compare radiation exposure, safety and cost between conventional, electroanatomical (Carto) and high frequency electrical field (NavX) mapping techniques. Methods: All patients undergoing catheter ablation (except AV node and AF ablation) were randomised to a Carto, NavX or conventional mapping procedures. Immediate procedural success was defined using standard criteria (eg bi-directional block for typical atrial flutter, non inducibilty of AVNRT/AVRT etc). All patients were seen 6 weeks following the procedure and success defined as both freedom from symptoms and no documented recurrence of any arrhythmia other than ectopy. Procedure costs included diagnostic and ablation catheters, Carto reference patch and the complete NavX kit. All costs are the published UK list prices. Statistical comparison was made against conventional procedures. Results: Eighty-nine patients (54% men) aged 48 17 (mean SD) were randomised. 5 patients were withdrawn as no arrhythmia could be induced. There were no significant differences between Carto and NavX in any variable. Conclusion: For all catheter ablation procedures, procedure duration and outcome are similar for Carto, Navx and conventional procedures. Both Carto and NavX are associated with reduced fluoroscopy time and radiation dose compared to conventional x-rays but at an increased cost. The costs of NavX are likely to reduce as we become more comfortable using fewer catheters for EP procedures.