Factors Influencing Stereotaxic Pulmonary Vein Isolation Volume 3 - Issue 3

Jean-Baptiste Guichard¹*, Antoine Da Costa¹, Nicolas Maillard², Cécile Romeyer¹, Pierre Croisille³ and Karl Isaaz¹

• ¹Department of Cardiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France
• ²Department of Nephrology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France
• ³Department of Radiology, University Hospital of Saint-Étienne, University Jean Monnet, Saint-Étienne, France

Received:January 08, 2021;   Published: January 20, 2021

Corresponding author: Dr Guichard JB, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42000 Saint-Etienne, France

DOI: 10.32474/ACR.2021.03.000164

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Abstract

Background – Catheter ablation of atrial fibrillation (AF) is performed to restore and maintain a sinus rhythm. Remote magnetic navigation system (RMNS) allows an efficient and safe procedure. Left atrial (LA) anatomic barriers of this device are not well known. Aims – This study was aimed to evaluate clinical, echocardiographic and cardiac computed tomography (CCT) anatomic LA characteristics as predictors of stereotaxic AF procedure duration. Methods – From February 2015 to April 2016, 102 symptomatic and drug refractory AF patients were consecutively enrolled in an observational, prospective trial when first AF ablation. AF Radiofrequency (RF) was performed with a RMNS using Niobe ES. Clinical endpoints and LA characteristics were reported, prospectively by a transthoracic and transesophageal echocardiography, and CCT scan. Results – Mean patient age was 5912 years old, 77% male, mean CHA2DS2VASc of 1.31.3 and mean LA surface of 236.5cm2. Procedure duration of 97.232.9 minutes and fluoroscopy duration of 13.47.9 minutes were recorded. Persistent versus paroxysmal AF (p<0.05), previous flutter ablation (p<0.01), LA dilation (p<0.05), narrow LA ridge (p=0.01), small surface area and high eccentricity of the left inferior pulmonary vein (LIPV) (p<0.01) are correlated to an increased procedure duration. Previous flutter ablation (p<0.01), persistent AF (p<0.05), LIPV eccentricity (p<0.05) and ridge width (p=0.05) were found to be independently associated with procedure duration. Conclusion – Our study is the first analyzing predictors of stereotaxic procedure duration. Narrow LA ridge, small and flattened LIPV were independently correlated with an increased procedure duration. Yet neither co-morbidity nor cardiomyopathy was associated to procedure changes.

Keywords: Atrial fibrillation ablation; pulmonary vein isolation; remote magnetic navigation; procedure duration; anatomic characteristics

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