Different image integration modalities to guide AF ablation: impact on procedural and fluoroscopy times

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Atrial fibrillation (AF) ablation utilizes various image integration modalities.
• The impact of these modalities on procedural and fluoroscopy times remains unevaluated.

Purpose of the Study:

• To compare the procedural and fluoroscopy times of different image integration modalities during AF ablation.
• To assess the effectiveness of pulmonary vein (PV) disconnection using various imaging techniques.

Main Methods:

• Sixty patients with symptomatic drug-refractory AF underwent pulmonary vein (PV) encircling and disconnection.
• Patients were randomized into three groups: CARTO with preprocedural MRI, CARTO with intracardiac echocardiography (ICE), and CARTO with both MRI and ICE.
• Procedural and fluoroscopy times, as well as time spent in the left atrium, were recorded and compared.

Main Results:

• PV disconnection was successful in all patients.
• ICE integration significantly reduced fluoroscopy time and time in the left atrium compared to MRI integration alone.
• Procedural times were similar across all groups; however, MRI integration led to longer fluoroscopy times.

Conclusions:

• ICE image integration is superior to MRI integration alone in reducing fluoroscopy time and left atrial dwell time during AF ablation.
• Combining MRI with ICE does not decrease procedural time and may increase fluoroscopy time.