Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2016; 8(4): 317-322
Published online Apr 26, 2016. doi: 10.4330/wjc.v8.i4.317
Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation
Ibrahim Marai, Mahmoud Suleiman, Miry Blich, Jonathan Lessick, Sobhi Abadi, Monther Boulos
Ibrahim Marai, Mahmoud Suleiman, Miry Blich, Jonathan Lessick, Monther Boulos, the Division of Pacing and Electrophysiology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
Sobhi Abadi, Department of Diagnostic Imaging, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Rambam Health Care Campus.
Informed consent statement: Patients were not required to give informed consent to this retrospective study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ibrahim Marai, MD, the Division of Pacing and Electrophysiology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haalia Hashnia Street 6, Haifa 31096, Israel. i_marai@rambam.health.gov.il
Telephone: +972-4-8542180 Fax: +972-4-8542354
Received: June 28, 2015
Peer-review started: June 29, 2015
First decision: July 31, 2015
Revised: January 29, 2016
Accepted: February 16, 2016
Article in press: February 17, 2016
Published online: April 26, 2016
Abstract

AIM: To investigate the impact of using computed tomography (CT) and contact force (CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation (AF) ablation.

METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation (PVI) for AF during 2012 and 2013 guided by CT image integration (Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping (EAM) system (CT group) using standard irrigated radiofrequency catheter (ThermoCool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor (Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter (ThermoCool) using only EAM (Carto) system (EAM group). Linear lesions were performed according to the discretion of operator.

RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group (81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant (73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up (100% vs 73%; respectively; P = 0.07). Major complications (pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.

CONCLUSION: These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.

Keywords: Atrial fibrillation, Catheter ablation, Image integration, Contact force

Core tip: The aim of this nonrandomized study was to determine the impact of integrating computed tomography (CT) image of left atrium into electroanatomical mapping (EAM) system and using of contact force (CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation (AF) ablation. We found that combination of CT image integration into EAM and CF technology might reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF during follow-up period of 24 mo.