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Effect of Electroanatomically Guided Versus Conventional Catheter Ablation of Typical Atrial Flutter on the Fluoroscopy Time and Resource Use: A Prospective Randomized Multicenter Study
Author(s) -
HINDRICKS GERHARD,
WILLEMS STEFAN,
KAUTZNER JOSEF,
DE CHILLOU CHRISTIAN,
WIEDEMANN MICHAEL,
SCHEPEL SIEP,
PIORKOWSKI CHRISTOPHER,
RISIUS TIM,
KOTTKAMP HANS
Publication year - 2009
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2009.01439.x
Subject(s) - medicine , ablation , atrial flutter , fluoroscopy , catheter ablation , multicenter trial , prospective cohort study , catheter , radiofrequency ablation , cardiology , randomized controlled trial , atrial fibrillation , multicenter study , surgery
Aims: Radiofrequency catheter ablation of typical atrial flutter is one of the most frequent indications for catheter ablation in electrophysiology laboratories today. Clinical utility of electroanatomic mapping systems on treatment results and resource utilization compared with conventional ablation has not been systematically investigated in a prospective multicenter study. Methods and Results: In this prospective, randomized multicenter study, the results of catheter ablation to cure typical atrial flutter using conventional ablation strategy were compared with electroanatomically guided mapping and ablation (Carto®). Primary endpoints of the study were procedure duration and fluoroscopy exposure time, secondary endpoints were acute success rate, recurrence rate, and resource utilization. A total of 210 patients (169 men, 41 women, mean age 63 ± 10 years) with documented typical atrial flutter were included in the study. Acute ablation success, that is, demonstration of bidirectional isthmus block, was achieved in 99 of 105 patients (94%) in the electroanatomically guided ablation group and in 102 of 105 patients (97%) in the conventional ablation group (P > 0.05). Total procedure duration was comparable between both study groups (99 ± 57 minutes vs 88 ± 54 minutes, P > 0.05). Fluoroscopy exposure time was significantly shorter in the electroanatomically guided ablation group (7.7 ± 7.3 minutes vs 14.8 ± 11.9 minutes; P < 0.05). Total recurrence rate of typical atrial flutter at 6 months of follow‐up was comparable between the 2 groups (respectively for the CARTO and conventional group 6.6% vs 5.7%, P > 0.05). The material costs per procedure in the electroanatomically guided and conventional groups (NaviStar® DS vs Celsius® DS) was €3035 (USD 3,870) and €2133 (USD 2,720), respectively. Conclusions: This multicenter study documented that cavotricuspid isthmus ablation to cure typical atrial flutter was highly effective and safe, both in the conventional and the electroanatomically guided ablation group. The use of electroanatomical mapping system significantly reduced the fluoroscopy exposure time by almost 50%, however, at the expense of increased cost of the procedure.