In this study, researchers looked at the lack of stable access to all desired ablation target sites as one of the limitations for effective circumferential left atrial pulmonary vein ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation, or AF, mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath.
The case-control-analysis included 245 consecutive patients as the control group treated with circumferential left atrial pulmonary vein ablation and were matched with 105 subsequently consecutive patients as the experimental group who were ablated with a similar line concept but mapping and ablation was performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% after a single procedure and 6 months of follow-up. With respect to procedural data, no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency burning time. With the steerable sheath mean procedural radiofrequency power and total RF energy delivery were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52%. The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early post-interventional arrhythmia recurrences was the only but powerful predictor for long-term ablation success.
The researchers concluded that an AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial pulmonary vein ablation at similar intervention times and similar complication rates. The 6-month success rate after a single LA intervention increased from 56% to 77%.
