Electroanatomic imaging (CARTO) for catheter ablation yielded similar acute procedural success to conventional mapping (91.5% vs 92.7%, P>0.5) but significantly reduced fluoroscopy time and radiation.
RCT (n=102)
Randomized
Does electroanatomic imaging (CARTO) reduce radiation exposure and improve outcomes compared to conventional fluoroscopic mapping in patients undergoing catheter ablation?
Routine use of electroanatomic mapping (CARTO) for catheter ablation drastically reduces fluoroscopy time and radiation exposure without compromising procedural success or duration.
Absolute Event Rate: 91.5% vs 92.7%
p-value: p=> 0.5
INTRODUCTION: The aim of this prospective randomized study was to compare the routine use of electroanatomic imaging (CARTO) with that of conventional fluoroscopically guided activation mapping (conventional) in an unselected population referred for catheter ablation. We sought to compare the two approaches with respect to procedure outcome and duration, radiation exposure, and cost. METHODS AND RESULTS: All patients undergoing catheter ablation (with the exception of complete AV nodal ablation) were prospectively randomized to either a CARTO or conventional procedure for mapping and ablation. One hundred two patients were randomized. Acute procedural success was similar with either strategy (CARTO vs conventional 43/47 vs 51/55, P > 0.5), as was procedure duration (144 58 vs 125 48 min, P = 0.07 (mean SD). CARTO was associated with a substantial reduction in fluoroscopy time (9.3 7.6 vs 28.8 19.5 min, P < 0.001) and radiation dose (6.2 6.1 vs 20.8 32.7 Gray, P = 0.003). CARTO cases used fewer catheters (2.5 0.7 vs 4.4 1.1, P < 0.001), but catheter costs were higher (13.8 vs 9.3 units, P < 0.001, where one unit is equivalent to the cost of a nonsteerable quadripolar catheter). CONCLUSION: For all catheter ablation procedures, even when a center's "learning curve" for CARTO is included, procedure duration and outcome are similar for CARTO and conventional procedures. CARTO is associated with drastically reduced fluoroscopy time and radiation dose. Although fewer catheters are used with CARTO, catheter costs remain higher.
Sporton et al. (Mon,) conducted a rct in Catheter ablation (n=102). Electroanatomic imaging (CARTO) vs. Conventional fluoroscopically guided activation mapping was evaluated on Acute procedural success (p=> 0.5). Electroanatomic imaging (CARTO) for catheter ablation yielded similar acute procedural success to conventional mapping (91.5% vs 92.7%, P>0.5) but significantly reduced fluoroscopy time and radiation.