Use of a new non-fluoroscopic three-dimensional mapping system in type I atrial flutter ablation

We studied 40 patients who underwent cavo-tricuspid isthmus ablation for typical counterclockwise atrial flutter with cooled tip catheters between 2001 and 2003. Complete bi-directional isthmus block was created in all patients. A new, three-dimensional (3D), non-fluoroscopic mapping system was used in 20 patients (test group), and conventional fluoroscopy in 20 others (conventional group), using anatomic and electrophysiologic criteria in both groups. We measured the total procedure, ablation procedure, and overall fluoroscopy times, and the total number of radiofrequency (RF) applications delivered in the two groups. The overall fluoroscopy time was shorter in the test group (mean 8.8 minutes, range 2-17 minutes) than the conventional group (29.7 minutes, range 12-57 minutes; P < 0.001). Though the overall procedure time was similar in both groups (92.5 +/- 28.6 minutes vs 106.5 +/- 20.9 minutes; P = 0.067) the ablation duration (25.1 +/- 6.6 minutes versus 43.3 +/- 19.6 minutes; P = 0.0051) and the total RF applications (10.6 +/- 9.4 versus 16.4 +/- 9.4; P = 0.044) were smaller in the test group. The use of a new, 3D non-fluoroscopic mapping system markedly reduced the fluoroscopy exposure during typical atrial flutter ablation. It was also associated with a significant reduction in ablation time and in the number of RF applications. Since atrial flutter ablation is one of the most frequently performed procedures, this system may significantly reduce the overall amount of radiation exposure in high-volume laboratories.