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Improved Electrogram Attenuation during Ablation of Paroxysmal Atrial Fibrillation with the Hansen Robotic System
Author(s) -
DUNCAN EDWARD R.,
FINLAY MALCOLM,
PAGE STEPHEN P.,
HUNTER ROSS,
GOROMONZI FARAI,
RICHMOND LAURA,
BAKER VICTORIA,
GINKS MATTHEW,
EZZAT VIVIENNE,
DHINOJA MEHUL,
EARLEY MARK J.,
SPORTON SIMON,
SCHILLING RICHARD J.
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2012.03381.x
Subject(s) - ablation , medicine , atrial fibrillation , pulmonary vein , catheter ablation , cardiology , attenuation , ablation of atrial fibrillation , catheter , lesion , nuclear medicine , surgery , physics , optics
Background:Robotic catheter ablation aims to improve outcomes after ablation of atrial fibrillation (AF) through improved lesion quality. This study examined electrogram attenuation as a measure of efficacy in response to robotic (ROB) and manual (MAN) ablation.Methods:Patients with paroxysmal AF undergoing ablation as part of an ongoing randomized controlled trial were studied (Clinical Trials Registration NCT01037296). Patients underwent pulmonary vein isolation using NavX (St. Jude Medical, St. Paul, MN, USA). Patients were randomized to MAN or ROB catheter ablation using a 3.5‐mm irrigated‐tip catheter with standardized ablation settings. Bipolar electrogram voltage was measured at 0, 5, 10, 20, and 30 seconds after ablation onset. Distance from ablation lesion to the left atrial surface on NavX were calculated.Results:Similar ablation energy was delivered in ROB and MAN groups, achieving comparable rates of PV isolation (100% vs 98%). The bipolar voltages of 4,434 electrograms from 303 ablation lesions (146 ROB, 157 MAN) were measured. At 30 seconds, signal attenuation was greater in the ROB group than MAN (mean 65 ± 4% vs 55 ± 4% of baseline voltage, P < 0.01). A total of 2,064 NavX ablation lesions were assessed (906 ROB and 1,158 MAN). ROB lesions were on average 0.52 mm further inside the geometry than MAN (P < 0.0001).Conclusions:Robotic ablation results in greater signal attenuation in man. This is achieved despite manual lesions being closer to the left atrial surface. Catheter stability and constant energy delivery may be key to achieving signal attenuation, rather than increased contact force. (PACE 2012; 35:730–738)