Visualization of multiple catheters in left atrial ablation procedures. Comparison of two different 3D mapping...

Visualization of intracardiac catheters placed in predefined anatomic locations is a cornerstone for successful atrial fibrillation (AF) ablation. The 3D mapping system Carto3™ (Biosense Webster, Diamond Bar, CA, USA) released in 2009 provides the possibility to visualize more than one intracardiac catheter at a time. The aim of the study was to evaluate the feasibility and safety of the system, to show the learning curve, and to compare it to the established Ensite NavX™ system regarding procedural handling parameters.

A total of 100 patients were enrolled in the study. The Carto3™ system was used by a team of four specialized operators in 50 patients (mean age 62±9 years, paroxysmal AF n=28, persistent AF n=17, left atrial flutter n=5). Patients were consecutively enrolled and matched (regarding type of ablated arrhythmias, ablation strategy, left atrial size, age, and gender) with patients ablated during the same time period with the EnSite NavX™ system. In patients with paroxysmal AF, ostial pulmonary vein isolation (PVI) was performed. Patients with persistent AF underwent PVI plus additional ablation of complex fractionated atrial electrograms (CFAE) and patients with left atrial flutter were treated with specific lines.

In 50 case-control pairs, all procedures were performed as planned without complications in both groups except one cardiac tamponade in 1 patient in the Ensite NavX™ control group. The learning curve using the Carto3™ system was fast regarding x-ray time and procedural duration and reached the level of the EnSite NavX™ system after 15 and 25 patients, respectively.

The Carto3™ system with its feature of visualizing several catheters is feasible and safe compared to an established system, e.g., Ensite NavX™. The learning curve is steep regarding reduction of x-ray time and procedural duration.