What is the clinical evidence from this study?

Study design: Observational. Population: Atrial tachycardia (n=51). Intervention: EnSite array-guided radiofrequency catheter ablation. Primary outcome: Acute success of atrial tachycardia elimination.

December 25, 2009Open Access

Radiofrequency Catheter Ablation of Atrial Tachycardia Under Navigation Using the EnSite Array

Key Result

EnSite array-guided radiofrequency catheter ablation successfully eliminated atrial tachycardia in 99% of patients, with a recurrence rate of 2.7% over a mean follow-up of 16 months.

Study Design

Type

Observational (n=51)

Multicenter

Structured PICO

Does EnSite array-guided radiofrequency ablation safely and effectively eliminate atrial tachycardia?

Population

51 patients with 74 atrial tachycardias (ATs), mean age 57+/-18 years, 28 males; 14 had previous open heart surgery and 5 had organic heart disease.

Intervention

Radiofrequency ablation (RFA) guided by the EnSite array (EA)

Outcome

AT termination and subsequent non-inducibility

EnSite array-guided radiofrequency ablation is a safe and highly effective approach for eliminating atrial tachycardia, achieving high procedural success and long-term symptom relief.

Limitations

Inaccurate virtual activation analysis in low-voltage zones and tunnel-like structures (e.g., superior vena cava, coronary sinus, pulmonary veins)
Unipolar electrograms may be hampered by large, remote electrical activity of depolarization or repolarization
Inapplicable to patients with a gigantic atrium because local activation at an endocardial site more than 4.0 cm from the center of the EnSite array is inaccurate

Abstract

BACKGROUND: Atrial tachycardia (AT) is sometimes difficult to eliminate by radiofrequency ablation (RFA), but the EnSite array (EA) visualizes the beat-to-beat virtual activation of any tachycardia. METHODS AND RESULTS: The 51 patients with 74 ATs (mean age 57+/-18 years, 28 males) undergoing EA-guided RFA were included; 14 patients had had previous open heart surgery and 5 had organic heart disease. RFA was performed at the AT focus for focal AT (n=48) with an endpoint of AT termination and subsequent non-inducibility. RFA was performed at a critical conducting pathway for reentrant AT (n=26) with creation of a block line in the critical reentry circuit. EA revealed that 57 ATs originated in the right atrium (77%) and 17 originated in the left atrium (23%); all but 1 were successfully eliminated. Fluoroscopic time was 19+/-11 min, the number of RFA applications was 8+/-7, and the radiofrequency energy was 10,711+/-12,655 J. No complications were noted. All but 2 patients were free of any symptoms during a follow-up of 16+/-9 months. CONCLUSIONS: EA-guided RFA is safe and effective for AT, irrespective of its mechanism, sustainability or origin, and regardless of underlying heart disease. (Circ J 2010; 74: 59 - 65).

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