Abstract
Background: Rotational angiography of the left atrium with 3-dimensional reconstruction (3DATG) is a new imaging tool to guide atrial fibrillation (AF) ablation. The purpose of this study was to compare the procedural outcome and radiation exposure of patients with AF treated by catheter ablation using either conventional electroanatomical mapping system (CARTO) or 3DATG. Methods: One hundred twenty-eight consecutive patients with AF treated by Catheter Ablation using either 3D-ATG (75 patients) or CARTO (53 patients) were included. 3DATG was performed by using the Philips Allura Xper FD 10 system operated at a low-frame pulsed fluoroscopy (7.5 frames per second). Intraoperative 3DATG was performed with contrast medium injection directly into the bilateral upper pulmonary veins, during rapid ventricular pacing. Contrast-enhanced computed tomography-fluoroscopy overlay system (CCT) was also performed preoperatively for all patients. We evaluated vertical ostial pulmonary vein (PV) diameters and left atrial (LA) diameter, time needed to perform PV isolation, and radiation exposure for each imaging method. Results: Time required for PV isolation using 3DATG was significantly shorter than that using CARTO (104±31min. vs. 124±41min.; p<0.05). Mean fluoroscopy durations for AF ablation with 3DATG were 63±21 minutes in the anteroposterior (AP) and 51±25 minutes in the left anterior oblique (LAO) projection. The mean radiation exposure measured with air kerma was 356±177 mGy in the AP and 410±358 mGy in the LAO projection. Surface radiation dosage using 3DATG was significantly reduced compared with CCT (0.040±0.021 mGy vs. 1.017±0.205 mGy; p<0.001). The effective dose from CCT was 15.2±4.0 mSv. The vertical PV ostial diameters and the LA diameter in 3DATG almost accorded with those in CCT (left upper PV: 20.3±2.7mm vs. 21.8±4.1mm. r=0.72; p<0.001, right upper PV: 19.5±3.0mm vs. 20.4±3.6mm. r=0.60; p<0.01, LA longitudinal diameter: 66.4±5.2mm vs. 66.8±6.2mm. r=0.79; p<0.001). Conclusion: 3DATG-guided AF ablation has similar radiation exposure and procedural and outcome characteristics compared with CARTO-guided ablation. 3DATG is a reasonable alternative to conventional 3D electroanatomical mapping systems.
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