The impact of image integration on catheter ablation of atrial fibrillation using electroanatomic mapping: a prospective randomized study

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Abstract
A detailed appreciation of the left atrial/pulmonary venous (LA/PV) anatomy may be important in improving the safety and success of catheter ablation for AF. The aim of this randomized study was to determine the impact of computed tomographic (CT) integration into an electroanatomic mapping (EAM) system on clinical outcome in patients undergoing catheter ablation for atrial fibrillation (AF). Eighty patients with AF were randomized to undergo first-time wide encirclement of ipsilateral PV pairs using EAM alone (40 patients) or with CT (40 patients, Cartomerge®). Wide encirclement of the pulmonary veins was performed using irrigated radiofrequency ablation with the electrophysiological endpoint of electrical isolation (EI). The primary endpoint was single-procedure success at 6 month follow up. Acute and long-term procedural outcomes were also determined. There was no significant difference in single procedure success between EAM (56%) and cavotricuspid isthmus image (CTI) (50%) groups (P = 0.9). Acute procedural outcomes (EI, PV reconnection, sinus rhythm restored by ablation in persistent AF), fluoroscopy, and procedure durations (EI of right PVs, EI of left PVs, total) did not differ significantly between EAM and CTI groups. Image integration to guide catheter ablation for AF did not significantly improve the clinical outcome. Achieving PV EI is the critical determinant of procedural success rather than the mapping tools used to achieve it.