Key result
Narrow left atrial ridge, small and flattened left inferior pulmonary vein, persistent AF, and previous flutter ablation were independently correlated with increased stereotaxic procedure duration.
Why the study?
While remote magnetic navigation systems allow efficient and safe AF ablation, left atrial anatomic barriers of this device are not well known.
What clinical and anatomic factors predict procedure duration during stereotaxic pulmonary vein isolation for atrial fibrillation?
Observational (n=102)
Single-blind
No
What clinical and anatomic factors predict procedure duration during stereotaxic pulmonary vein isolation for atrial fibrillation?
Narrow LA ridge, small and flattened LIPV, persistent AF, and previous flutter ablation independently predict increased procedure duration during stereotaxic pulmonary vein isolation.
Background -Catheter ablation of atrial fibrillation (AF) is performed to restore and maintain a sinus rhythm. Remote magnetic navigation system (RMNS) allows an efficient and safe procedure. Left atrial (LA) anatomic barriers of this device are not well known. Aims -This study was aimed to evaluate clinical, echocardiographic and cardiac computed tomography (CCT) anatomic LA characteristics as predictors of stereotaxic AF procedure duration. Methods -From February 2015 to April 2016, 102 symptomatic and drug refractory AF patients were consecutively enrolled in an observational, prospective trial when first AF ablation. AF Radiofrequency (RF) was performed with a RMNS using Niobe ES. Clinical endpoints and LA characteristics were reported, prospectively by a transthoracic and transesophageal echocardiography, and CCT scan. Results -Mean patient age was 5912 years old, 77% male, mean CHA2DS2VASc of 1.31.3 and mean LA surface of 236.5cm2. Procedure duration of 97.232.9 minutes and fluoroscopy duration of 13.47.9 minutes were recorded. Persistent versus paroxysmal AF (p<0.05), previous flutter ablation (p<0.01), LA dilation (p<0.05), narrow LA ridge (p=0.01), small surface area and high eccentricity of the left inferior pulmonary vein (LIPV) (p<0.01) are correlated to an increased procedure duration. Previous flutter ablation (p<0.01), persistent AF (p<0.05), LIPV eccentricity (p<0.05) and ridge width (p=0.05) were found to be independently associated with procedure duration. Conclusion -Our study is the first analyzing predictors of stereotaxic procedure duration. Narrow LA ridge, small and flattened LIPV were independently correlated with an increased procedure duration. Yet neither co-morbidity nor cardiomyopathy was associated to procedure changes.
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Jean-Baptiste Guichard (2021) conducted an observational in Symptomatic and drug refractory atrial fibrillation (n=102). Clinical and anatomical factors (e.g., narrow LA ridge, LIPV eccentricity, persistent AF) vs. Absence of these factors was evaluated on Stereotaxic AF procedure duration. Narrow left atrial ridge, small and flattened left inferior pulmonary vein, persistent AF, and previous flutter ablation were independently correlated with increased stereotaxic procedure duration.
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