Circumferential pulmonary vein isolation guided by image integration reduced atrial tachyarrhythmia relapse (22.6%) compared to segmental (44.6%) or 3D mapping alone (41.7%; P<0.0001).
Cohort (n=573)
Yes
Does circumferential pulmonary vein isolation guided by image integration improve procedural and clinical outcomes in patients undergoing first catheter ablation for paroxysmal atrial fibrillation compared to segmental isolation or 3D mapping alone?
Image integration with MR/CT during circumferential pulmonary vein isolation significantly reduces atrial tachyarrhythmia relapse compared to 3D mapping alone or segmental isolation in patients with paroxysmal atrial fibrillation.
Absolute Event Rate: 22.6% vs 41.7%
p-value: p=<0.0001
AIMS: The aim of this study was to investigate whether circumferential pulmonary vein (PV) isolation guided by image integration improves the procedural and clinical outcomes of atrial fibrillation (AF) ablation in comparison with segmental PV isolation and circumferential PV isolation guided by three-dimensional (3D) electroanatomical mapping alone. METHODS AND RESULTS: Procedural and clinical outcomes of 573 patients who underwent their first catheter ablation for paroxysmal AF between January 2005 and April 2007 were collected from 12 centres. We evaluated three techniques: segmental ostial PV isolation (SOCA group, 240 patients), circumferential PV isolation guided by electroanatomical mapping (CARTO group, 107 patients), and circumferential PV isolation guided by electroanatomical mapping integrated with magnetic resonance/computed tomographic images of the left atrium (MERGE group, 226 patients). Procedure duration proved to be shorter in MERGE group patients than in CARTO group patients (P < 0.04), but longer than in SOCA group patients (P < 0.0001). During follow-up, atrial tachyarrhythmias relapsed more frequently in SOCA group patients (44.6%) and CARTO group patients (41.7%) than in MERGE group patients (22.6%; P < 0.0001). CONCLUSION: In patients with paroxysmal AF, circumferential PV isolation guided by image integration significantly improves clinical outcome in comparison with both circumferential PV isolation guided by 3D mapping alone and with segmental electrophysiologically guided PV isolation.
Bertaglia et al. (2009) conducted a cohort in paroxysmal atrial fibrillation (n=573). Circumferential PV isolation guided by image integration (MERGE) vs. Segmental ostial PV isolation (SOCA) and circumferential PV isolation guided by 3D mapping alone (CARTO) was evaluated on Relapse of atrial tachyarrhythmias (p=<0.0001). Circumferential pulmonary vein isolation guided by image integration reduced atrial tachyarrhythmia relapse (22.6%) compared to segmental (44.6%) or 3D mapping alone (41.7%; P<0.0001).