Cor Vasa 2012, 54(11-12):e393-e400 | DOI: 10.1016/j.crvasa.2012.11.005

The influence of the technology on the success of the treatment of paroxysmal atrial fibrillation - Single center experience

Alan Bulava^a,b,c,*, Jiří Haniš^a

^a Kardiocentrum, Nemocnice České Budějovice, a. s., České Budějovice, Česká republika

^b I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^c Zdravotně sociální fakulta, Jihočeská univerzita v Českých Budějovicích, Česká republika

Introduction: Pulmonary vein isolation (PVI) is considered to be a cornerstone of invasive therapy of paroxysmal atrial fibrillation (PAF). However, numerous technologies appeared on the market during last 10 years and besides typical "point-by-point" ablation, other "single-burn" technologies or remote navigation emerged.
Goal: The aim of this article is to summarize single center experience with PVI using different technologies.

Methods and results: The study was conducted in partially retrospective and mainly prospective manner. Consecutive cohorts of patients with PAF were followed after their index procedure using four different systems (CARTO XP, pulmonary vein ablation catheter [PVAC], CARTO3 and Sensei robotic system). After 3-month blanking period, repeated 7-day Holters were carried out every three months following the index procedure, which consisted of catheter-based radiofrequency PVI. Documented episodes of AF lasting > 60 s on any of these 7-day Holters were considered a failure of treatment. Using of the PVAC technology was associated with the shortest procedure duration when compared to any other system (p < 0.0001 for all) and significant shortening of fluoroscopic time when compared to CARTO XP (p < 0.0001). Using of novel CARTO3 mapping system or robotic navigation led to significant decrease of procedural time when compared to older 3D mapping system CARTO XP (p < 0.0001). Arrhythmia free survival at 12 months following the index procedure was 65.8%, 68.7%, 75% and 76.1% when using CARTO XP, PVAC, CARTO3 and robotic navigation, respectively. Using of either CARTO3 or robotic navigation system led to significant improvement of AF-free survival (log-rank p < 0.01). One major vascular complication was recorded in the robotic group of patients while none in other groups. No minor or major late complications (beyond 30 days following the index procedure) were noted in any of the groups.

Conclusions: Novel technologies bring significantly better results in terms of arrhythmia recurrence and allow for shorter procedure duration and lower radiation burden both for patients and the operating physicians.

Keywords: Comparison of technologies; Duty-cycled radiofrequency energy; Paroxysmal atrial fibrillation; Pulmonary vein ablation catheter; Robotic technology; 3D mapping systems

Received: October 23, 2012; Accepted: November 9, 2012; Published: November 1, 2012  Show citation