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Published on: May 26, 2015
The Impact of a Visualized Steerable Sheath on Radiofrequency Catheter Ablation for First-Time Atrial Fibrillation
Chun-Kai Chen1,2, Chih-Chieh Yu1, Min-Tsun Liao1,2
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Background:
A 3D electroanatomical mapping (3D-EAM) visualized steerable sheath was designed to improve catheter placement and reduce radiation exposure during ablation, an established treatment for atrial fibrillation (AF). However, prospective randomized data comparing the procedural and clinical outcomes of visualized and non-visualized steerable sheaths are limited.
Aims:
To compare the impact of 3D-EAM visualized and nonvisualized steerable sheaths on procedural and clinical outcomes in patients undergoing AF ablation.
Methods:
This prospective randomized study included 100 patients who underwent radiofrequency catheter ablation for AF. Patients were randomized (1:1) to either a 3D-EAM-visualized steerable sheath (Vizigo) or a conventional non-visualized steerable sheath (Agilis) group. Key endpoints included procedure and fluoroscopy times, pulmonary vein isolation (PVI) effectiveness, and 12-month AF recurrence.
Results:
Acute PVI was successfully achieved in all patients. Fluoroscopy time was significantly lower in the Vizigo group than that in the Agilis group (11.43 vs. 15.37 min, p = 0.0013), with a zero-fluoroscopy workflow achievable post-transseptal puncture. First-pass PVI success in left-sided veins was significantly higher in the Vizigo group than that in the Agilis group (84% vs. 64%, p = 0.023). At the 12-month follow-up, AF-free survival was favored in the Vizigo group (91.8% vs. 83.3%; p = 0.203).
Conclusions:
Using a 3D-EAM visualized steerable sheath significantly reduced fluoroscopy time without prolonging the AF ablation procedure, making a zero-fluoroscopy ablation strategy feasible after transseptal puncture. Furthermore, the improved left-sided first-pass PVI success observed with the Vizigo sheath may have implications for procedural efficacy, although its effect on long-term outcomes warrants further investigation with larger cohorts.
