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Updated: Jun 24, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach
Klaus Kettering1, Gerald F Greil, Michael Fenchel
1Department of Cardiology, University of Mainz, Mainz, Germany. Klaus.Kettering@t-online.de
Insights
Three-dimensional imaging using CT or MRI significantly improves catheter ablation success rates for atrial fibrillation (AF) by providing detailed anatomical information. This approach enhances procedural safety and reduces arrhythmia recurrence.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Catheter ablation is a first-line therapy for drug-refractory atrial fibrillation (AF).
- Individual anatomical variability presents a challenge in AF catheter ablation.
- 3D imaging (CT, MRI) offers detailed left atrial and pulmonary vein morphology.
Purpose of the Study:
- To evaluate the preliminary experience with different AF ablation strategies.
- To assess the utility of CT/MRI-guided approaches using Navx/Ensite systems.
- To determine the impact of 3D anatomical visualization on procedural outcomes.
Main Methods:
- Pre-ablation 3D CT (n=34) or MRI (n=7) scans were acquired for 41 patients.
- 3D models of the left atrium were created and displayed in the Navx/Ensite system.
- Ablation strategies included pulmonary vein isolation, linear lesions, or a combined approach.
Main Results:
- CT scans provided more detailed left atrial anatomy reconstructions than MRI.
- High anatomical variability was observed, influencing ablation strategies.
- Arrhythmia recurrence rates were 20% (Group A), 33% (Group B), and 33% (Group C) at mean follow-ups of 359, 452, and 1000 days, respectively.
Conclusions:
- 3D CT/MRI reconstructions enhance the safety and efficacy of AF ablations with Navx/Ensite systems.
- Real-time 3D visualization of catheters is a significant advantage for pulmonary vein mapping.
- Personalized anatomical information improves catheter ablation outcomes in AF patients.
Background:
Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug refractory atrial fibrillation. However, catheter ablation of atrial fibrillation is still a challenge. This is partially due to the high degree of variability with regard to the individual anatomy. Nevertheless, 3D imaging systems (CT, MRI) provide detailed information about the individual left atrial and pulmonary vein morphology. A 3D CT or MRI reconstruction of the left atrium can be displayed in the Navx-/Ensite-system in a synchronised way during the ablation procedure, thereby facilitating the intervention. This study summarizes our preliminary experience with different strategies of AF ablation using the Navx-/Ensite-system and a CT-/MRI-guided approach.
Methods:
In a total of 41 patients, cardiac MRI (n = 7) or multi-detector spiral computed tomography (n = 34) was performed prior to an ablation procedure. Catheter ablation was performed for paroxysmal atrial fibrillation in 31 patients and for persistent atrial fibrillation in 10 patients. A 3D MRI or high resolution spiral CT data acquisition was performed and a surface rendered model of the LA was created. This model was displayed in the Navx-/Ensite-system throughout the ablation procedure.
Results:
Catheter ablation was performed using the Navx-system (n = 38) or the Ensite-system (n = 3). Three strategies were used depending on the type of atrial fibrillation: segmental isolation of the pulmonary veins (facilitated by a 3D real-time visualization of the ablation catheter and a circumferential mapping catheter; group A: 20 patients), linear lesions (group C: 3 patients) and a combined approach (group B; 18 patients). The CT-/MRI-models provided an excellent overview over the pulmonary veins and the left atrial appendage. They revealed a high degree of variability with regard to the individual anatomy (e.g. dimensions of the left atrial appendage, pulmonary vein ostia). The CT scans provided a more detailed reconstruction of the left atrial anatomy than the MRI scans (especially in patients who were in atrial fibrillation at the time of the data acquisition). In some patients, the CT-/MRI-models revealed a very small diameter of some pulmonary veins or side branches close to the ostium (e.g. right inferior pulmonary vein). Therefore, no attempt was made to achieve complete pulmonary vein isolation in some patients. In group A, 16/20 (80%) patients had no arrhythmia recurrence [mean follow-up 359 days (SD +/- 317 days)]. Twelve out of eighteen (67%) patients in group B [mean follow-up 452 days (SD +/- 311 days)] and 2/3 (67%) patients in group C did not experience an arrhythmia recurrence [mean follow-up 1,000 days (SD +/- 34 days)]. There were no major complications.
Conclusions:
The information derived from 3D CT- or MRI-reconstructions facilitates AF ablations performed with the Navx-/Ensite-mapping system and enhances the safety of these procedures. Furthermore, the availability of an additional impedance-based 3D real-time visualization of the ablation catheter and the circular mapping catheter placed in the pulmonary veins represents a major advantage of the Navx system.
