Clin Res Cardiol 101, Suppl 1, April 2012

V1167 - Novel visually guided left atrial isthmus ablation using a robotic navigation system: safety, feasibility and clinical outcome
 
A. Rillig1, B. Schmidt1, B. Feige1, E. Wißner1, A. Metzner1, S. Mathew1, P. Wohlmuth2, F. Ouyang1, K.-H. Kuck1, R. R. Tilz1
 
1II. Medizinische Abteilung, Fachabt. Kardiologie, Asklepios Klinik St. Georg, Hanseatisches Herzzentrum Hamburg, Hamburg; 2Proresearch, Asklepios Klinik St. Georg, Hamburg;
 
Background: In patients with persistent and longstanding persistent atrial fibrillation (LS-AF) left atrial isthmus (LAI) ablation in addition to CPVI may improve clinical outcome. However, the endpoint of bidirectional LAI block is difficult to pertain.
To date no systematic evaluation exists reporting on the feasibility, efficacy and safety of LAI-ablation using a remote robotic navigation system (RNS).
Methods: In 90 patients (16 (17,8%) female, median age 64 (54-68) years) with persistent (n=59) or LS-AF either CPVI with LAI-ablation (LAI-Group) or CPVI only (NLAI-group) was performed using RNS. In all patients, CPVI was performed using the RNS in combination with a 3D electroanatomical mapping system. The left atrial appendage (LAA) was visualized by selective angiography prior to LAI-ablation in all patients.
LAI-ablation was performed using either a 3,5mm irrigated tip catheter with 6 (LAI-group-A; max. 40 W, contact force 10-40g) or a 4mm irrigated tip catheter with 12 irrigation holes (LAI-group-B; max. 30W, contact force 10-30g).
Success rate was evaluated with 24h-holter monitoring at 12-months follow-up.
Results: Success rate of LAI-block was 100% using the RNS. Epicardial ablation was necessary in 6/42 (14.3%) pts. of the LAI-group (2 pts LAI-1 and 4 pts LAI-2). Overall procedure time was significantly longer in the LAI-group compared to the NLAI-group (225 (170-240) vs 180 (159.5-205); p<0.01). Median procedure time (44.5 (25.5-65 vs 43 (30-65); p=0.83) for LAI-ablation were similar in LAI-group-A and LAI-group-B. In one patient of LAI-group-1 a steam pop occurred during LAI-ablation leading to cardiac tamponade requiring cardiac surgery and in one pt of LAI-group one TIA occurred 10 days after the ablation procedure.
Single-procedure success-rate at 12-months-FU in LAI-group and NLAI-group did not differ significantly (28/42 (66.7%) pts vs 30/48 (62.5%) pts; p=0.68).
Conclusion: LAI-ablation using RNS with new RF ablation catheters with increased irrigation in combination with power reduction to 30W and max. contact force of 30g seems to be feasible with an acute success rate of 100%; epicardial ablation was only necessary in 14.3% of patients. In this study, additional LAI ablation did not improve procedural outcome.
 
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/V1167.htm