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Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training

Jorge Romero1, Florentino Lupercio1, David Goodman-Meza1

  • 1Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|November 13, 2015
PubMed
Summary

Three-dimensional electroanatomic mapping (EAM) systems did not improve outcomes in teaching cases for radiofrequency catheter ablation (RFCA). These systems significantly increased procedure and fluoroscopy times, suggesting a need for new training strategies.

Keywords:
Conventional mappingFluoroscopy timeRadio frequency ablationTeaching programTridimensional mapping

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Three-dimensional electroanatomic mapping (3-D EAM) systems are used in radiofrequency catheter ablation (RFCA) to reduce radiation exposure.
  • Complex RFCA procedures have a steep learning curve, requiring trainees and mentors to use multiple imaging modalities, potentially increasing procedure and fluoroscopy times.
  • This study evaluates the impact of 3-D EAM systems on procedural outcomes during RFCA in an academic teaching hospital.

Purpose of the Study:

  • To determine if 3-D EAM systems (CARTO and ESI-NavX) improve procedural outcomes compared to conventional fluoroscopic guidance during RFCA in a teaching setting.
  • To assess the effect of 3-D EAM on fluoroscopy time, radiofrequency time, procedure duration, complication rates, and success rates.

Main Methods:

  • Analysis of 1070 consecutive RFCA procedures over 8 years.
  • Stratification of fluoroscopic time by ablation target and mapping system.
  • Multivariate logistic regression and adjusted odds ratios were calculated to compare outcomes between 3-D EAM and conventional mapping.

Main Results:

  • No significant differences in acute success rates were observed between 3-D EAM (CARTO, ESI-NavX) and conventional mapping.
  • Complication rates were also not significantly different between the groups.
  • Procedure, radiofrequency, and fluoroscopy times were significantly longer with CARTO and ESI-NavX compared to conventional mapping (e.g., fluoroscopy time: CARTO 28.3 min, ESI 28.5 min, conventional 24.3 min).

Conclusions:

  • The use of 3-D EAM systems during teaching cases for RFCA significantly increases radiation exposure compared to conventional mapping.
  • Current findings indicate a need for alternative training strategies to improve trainee confidence and safety.
  • Developing new approaches is crucial to reduce fluoroscopy and procedure times during RFCA in teaching environments.