The internal atrial cardioversion system required significantly lower energy (12.6±6.4J vs. 94.1±31.5J, P<0.01) and caused less catheter spatial change than external defibrillators.
Does an internal atrial cardioversion system improve mapping accuracy compared to external defibrillators in patients undergoing atrial fibrillation ablation?
Internal atrial cardioversion reduces catheter displacement and requires less energy compared to external defibrillation, preserving mapping accuracy during atrial fibrillation ablation.
Absolute Event Rate: 0% vs 0%
Abstract Background Cardioversion to restore sinus rhythm (SR) during the ablation procedure is common. External defibrillators (EDs) cause body movement and sometimes interfere with mapping procedures such as for non-pulmonary vein atrial fibrillation foci. The internal atrial cardioversion system (IAC: 20 pole right atria-coronary sinus electrode cardioversion catheter BeeAT™ and shock energy generator SHOCK AT™, Japan Lifeline Co., Ltd. Tokyo, Japan. Figure 1) has the potential to minimize body movements, however, little is known about the impact on the mapping accuracy. Purpose This study was conducted to assess the impact of the IAC on the mapping accuracy compared to EDs. Methods Thirty consecutive patients who underwent ablation procedures with IACs or EDs were enrolled. Cardioversion (CV) was performed with 10J to 30J with the IAC and 50-150J with the ED. Catheters with magnetic sensors were placed at anatomically stable locations prior to the CV and the spatial location was stored in the 3D mapping system. After the CV, no change in the catheter location was confirmed by fluoroscopy. The spatial changes in the stored catheter locations pre- and post-CV, CV success rate. and required energy to restore SR were compared between IACs and EDs. Results A total of 76 CVs among the enrolled patients (71yrs, 58% Male, BMI: 24±4, left atrial diameter: 45mm) using IACs (n=15) or EDs (n=15) were investigated. The CV success rates were 84%, 67%, and 100% with IACs at 10J, 20J, and 30J and 69%, 87%, and 67% with EDs at 50J, 100J, 150J, respectively. The required energy to restore SR with IACs and EDs was 12.6±6.4 vs. 94.1±31.5J (P0.01). Figure 2 shows the results of the spatial change in the catheter location. Spatial changes were equivalent between IAC 10-30J and ED 50J, however, the change in the catheter location with IAC 10J (2.1±1.0mm) was significantly lesser compared to ED 100 and 150J (4.2±2.8 and 4.5±2.8mm, both P0.01). Conclusion The required energy to restore SR with IACs was significantly lower than that for EDs without sacrificing the success rate. The spatial change of the catheters was less with IACs, indicating a lesser negative impact on the mapping accuracy.Internal atrial cardioversion system
Suzuki et al. (Sat,) reported a other. The internal atrial cardioversion system required significantly lower energy (12.6±6.4J vs. 94.1±31.5J, P<0.01) and caused less catheter spatial change than external defibrillators.