European Heart Journal Advance Access originally published online on April 13, 2006
European Heart Journal 2006 27(10):1223-1229; doi:10.1093/eurheartj/ehi834
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Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial
Cardiology Research Department, Queen Mary University of London and St Bartholomew's Hospital, Dominion House, West Smithfield, London EC1A 7BE, UK
Received 7 November 2005; revised 19 February 2006; accepted 23 February 2006; online publish-ahead-of-print 13 April 2006.
* Corresponding author. Tel: +44 2076018639; fax: +44 2076018627. E-mail address: r.schilling{at}qmul.ac.uk
See page 1134 for the editorial comment on this article (doi:10.1093/eurheartj/ehi862)
Aims To compare the utility of non-fluoroscopic mapping systems (Carto and Ensite NavX) with that of conventional mapping in patients referred for catheter ablation of a wide variety of arrhythmias.
Methods and results Patients referred for catheter ablation (excluding atrial fibrillation, atypical atrial flutter, ventricular tachycardia in structural heart disease, and complete AV nodal ablation) were randomized equally to a procedure guided by Carto, Ensite NavX, or conventional mapping. A total of 145 patients were recruited (82 men, aged 49±16, range 18–85). In 19 patients, no ablation was performed, and in the remaining, typical atrial flutter, atrioventricular nodal re-entrant tachycardia, and atrioventricular re-entrant tachycardias [including Wolff–Parkinson–White (WPW)] accounted for 93% of ablations. Overall procedure time, immediate and short-term success, complication rate, and freedom from symptoms at follow-up were identical for all groups. NavX led to the least X-ray exposure: Navx vs. conventional, median (range): 4 (0–50) vs. 13 (2–46) min (P<0.001); NavX vs. Carto, median (range): 4 (0–50) vs. 6 (1–55) min (P=0.008). Both Carto and NavX increased disposable costs by 50% when compared with conventional (P<0.001). For typical atrial flutter, Carto and NavX reduced screening times without increasing procedure cost. If ablation was not performed, NavX was twice as expensive as Carto or conventional.
Conclusion Ensite NavX and Carto procedures have similar effectiveness and safety to a conventional approach; however, they both reduce X-ray exposure, with NavX producing a significantly greater effect than Carto. Although this benefit is achieved at a greater financial cost, there may be long-term benefits to catheter laboratory staff.
Key Words: Arrhythmia • Catheter ablation • Non-fluoroscopic • Mapping
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