Co-Author(s):
Gustavo Morales, MD
Tina Hunter, PhD
Paul Zei, MD
Joshua Silverstein, MD
Carolyn Whitmire, MBA
Allyson Varley, PhD, MPH
Anil Rajendra, MD
Grandview Medical Center
Grandview Medical Center Alabama Cardiovascular Group 3686 Grandview
Parkway, Suite 720 Birmingham, AL
Introduction | Objectives: With advances in 3-dimensional (3D) electroanatomical mapping (EAM),
fluoroscopy utilization and procedure time during paroxysmal atrial
fibrillation (PAF) ablation have declined substantially. Recently, a new
sheath became available that can be visualized with 3D EAM. This may
further simplify ablation workflow and reduce fluoroscopy exposure. The
objectives of this study were to evaluate early user experience
incorporating the new EAM visualizable sheath into PAF ablations and to
compare outcomes to procedures performed without the sheath.
Methods: Consecutive de novo PAF procedures using a porous tip contact force
catheter at a high-volume site between January 2018 and May 2019 were
included. Procedures using the new EAM visualizable sheath were compared
to those performed without it. All ablations employed a standardized
low-fluoroscopy workflow. Pulmonary vein isolation was performed with
wide-area circumferential ablation, contact force was held between 10-20
grams, the catheter moved every 10-20 seconds, and radiofrequency (RF)
energy set at 40-45 watts throughout the atrium. Due to asynchronous
adoption of the sheath by operators of varying experience, analysis of
outcomes employed stabilized inverse probability of treatment weights to
balance cohorts by operator, age, sex, and
CHA2DS2-VASc score.
Results: Cohorts were similar at baseline (Table). Complications were few across
cohorts with no death or stroke. The EAM visualizable sheath cohort
reported 7 complications: arteriovenous fistula (1), cardiac
tamponade/pericardial effusion (2), hematoma (1), pseudoaneurysm (1),
pericarditis (2) versus the without EAM visualizable sheath cohort
reported 2 complications, cardiac tamponade/pericardial effusion and
pseudoaneurysm. Use of the EAM visualizable sheath was associated with
significant reduction in RF time and increase in ablations performed
without fluoroscopy (Table). There were fewer reablations at 12 months
in the EAM visualizable sheath cohort, but the difference was not
statistically significant due to low number of events (Table).
Conclusions: A 3D EAM visualizable sheath safely reduced RF time and facilitated
procedures performed without fluoroscopy, with no impact on clinical
outcomes.