Nonfluoroscopic magnetic electroanatomic mapping to facilitate focal pulmonary veins ablation for paroxysmal atrial fibrillation

Abstract

RF ablation of ectopic foci in the pulmonary veins (PVs) is a promising treatment for patients with paroxysmal AF. The aim of this study was to evaluate the feasibility of using nonfluoroscopic magnetic electroanatomic mapping of PV during spontaneous or induced ectopy to facilitate focal ablation procedure. The study included 35 patients with drug refractory paroxysmal AF who underwent focal RF ablation of the PV. In 10 (29%) patients, mapping and RF ablation procedures were performed using the nonfluoroscopic magnetic electroanatomic mapping system to enable automatic capture of the location and the timing of the ectopy. As a control, 25 patients underwent conventional endocardial activation mapping technique. There were no significant differences in the clinical characteristics between the two groups. Overall procedural duration was similar between them (199 ± 52 vs 221 ± 82 minutes, P > 0.05). However, the mean fluoroscopy time (25 ± 6 vs 52 ± 12 minutes, P = 0.01) and the mean number of RF applications (5 ± 3 vs 12 ± 9, P = 0.02) were significantly less in patients who underwent electroanatomic mapping. There were no significant differences between the two groups in the acute (90 vs 84%) and long-term success rate (60 vs 56%) after a mean follow-up of 12 ± 9 months. In conclusion, RF ablation of ectopic foci using non fluoroscopic magnetic electroanatomic mapping of PVs during spontaneous or induced ectopy is useful even in patients with a limited number of ectopy, and is associated with a similar success rate, but less fluoroscopy time and RF application compared to the conventional approach.