Predictors of long fluoroscopy time during ablation of atrial fibrillation

Abstract

Introduction Catheter ablation has emerged as effective therapy for AF. Ablation of AF is often a complex and long procedure requiring long fluoroscopy time. An important complication of AF ablation is the delayed effect of the radiation received by the patients and operator. Objective We conducted this prospective observational cohort to study factors associated with long fluoroscopy time during catheter ablation of AF. Patients and Method This is a prospective observational cohort study, conducted between January 2013 and January 2014 in Critical Care Medicine Department – Cairo University. Patients with symptomatic, drug refractory AF were enrolled. All patients underwent pulmonary vein isolation ± left atrial ablation according to AF type. All operators performed at least 50 previous AF ablation procedures. Clinical (AF type and LA geometry and diameter), and technical (Mapping system and catheters) variables were recorded for each patient. The primary endpoint was to identify variables associated with long fluoroscopy time. Secondary endpoints included identification of complications. Results Thirty-one patients with paroxysmal (n=25) and persistent (n=6) AF were enrolled. Pulmonary vein isolation was achieved in all patients. Average fluoroscopy time was 54.2 ± 31.7 mins. We found that the use of CARTO3® system was associated with significantly shorter fluoroscopy time compared to NavX EnSite Velocity® system (48 ± 29.8 vs. 78 ± 27.9 mins, P = 0.02). Using 20-pole circular mapping catheter was also associated with shorter fluoroscopy time as opposed to 10-pole one (47.6 ± 23.2 vs. 98.8 ± 48.4 mins, P = 0.03). Only two patients (6.4%) suffered major complications; major groin bleeding and pericardial tamponade. Conclusion The use of CARTO3® navigation system and 20-pole circular mapping catheter seems seems to be associated with shorter fluoroscopy time than EnSite Velocity® navigation system and 10-pole circular mapping catheter.