Reduction of fluoroscopy exposure and procedure duration during ablation of atrial fibrillation using a novel anatomical navigation system

Aims: Catheter ablation of atrial fibrillation (AF) is centred on pulmonary vein (PV) ablation with or without additional atrial substrate modification. These procedures may be prolonged with significant fluoroscopy exposure. This study evaluates a new non-fluoroscopic navigation system during ablation of AF. Methods and results: Seventy-two patients undergoing catheter ablation of symptomatic drug refractory AF were prospectively randomized to ablation with (n = 35; study group) or without (n = 37; control group) non-fluoroscopic navigation. PV isolation was performed in all patients. In patients with persistent or inducible sustained AF after PV isolation linear ablation was performed by joining the superior PVs. PV isolation was achieved in all patients; fluoroscopy (15.4 ± 3.4 vs. 21.3 ± 6.4 min; P < 0.001) and procedural (52 ± 12 vs. 61 ± 17 min; P = 0.02) durations were significantly reduced in the study group. Linear block was achieved in 37 of the 39 patients; with a significant reduction in fluoroscopy (5.6 ± 2.2 vs. 9.9 ± 4.8 min; P = 0.003) and procedural (14.7 ± 5.5 vs. 26.6 ± 16.9 min; P = 0.007) durations in the study group. After a follow-up of 6.9 ± 2.9 months (range 3-10), 26 (74%) patients in the non-fluoroscopic navigation group and 29 (78%) patients in the control group were arrhythmia-free after the first procedure. Conclusion: This prospectively randomized study demonstrates significant reduction of fluoroscopy exposure and procedural duration using supplementary non-fluoroscopic imaging system for AF ablation.