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C. Steinwender, R. Hofmann, A. Kypta, F. Leisch, 5. Atrial Tachycardia, Atrial Flutter & WPW Syndrome: 5.8 Ablation of Accessory Pathways Guided by the Localisa© Mapping-System Enhancement of Effectiveness and Reduction of Radiation Exposure, EP Europace, Volume 7, Issue s3, 2005, Page S9, https://doi.org/10.1016/j.eupc.2005.08.244
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Abstract
The LocaLisa© (LL) mapping-system (Medtronic Inc., Minneapolis, USA) provides non-fluoroscopic localisation of endocardial electrodes in a three-dimensional space and thus facilitates the movement of diagnostic and ablation catheters.
Using a low-energy stress-field, a virtual real-time display of all commercially available catheters allows more accurate manoeuvring and reduction of fluoroscopy time.
The aim of our study was to assess the efficacy of the LL mapping system in facilitating catheter ablation of accessory pathways (AP).
Between 2002 and 2004, catheter ablation of AP with LL-assistance was performed in a consecutive series of 32 patients (P, group I, G I). All clinical and procedural data were compared with those of 33 P, who had had a catheter ablation of an AP without LL-assistance between 2000 and 2002 (group II, G II). As primary success we defined the abolishment of all conducting properties of the AP. For left-sided AP, primarily a retrograde transaortic approach was intended. In case of ablation failure, simultaneous or staged transseptal puncture (TSP) with atrial mapping and subsequent ablation was performed.
Primary success rate was 97% (31 of 32 P, 1 P with 2 AP) in G I, compared to 85% (28 of 33 P, 1 P with AP and AVNRT) in G II (p = 0.09). Left-sided AP were balanced between both groups (G I: 27, G II: 26, p = ns), with the need for TSP to achieve successful ablation in 6 P in G I (22%) and in 12 P in G II (46%, p<0.05). The mean fluoroscopy time was 31,9 + 29,1 (7-113) minutes (min) in G I and 46,1 + 27,1 (7-108) min in G II (p<0.05). This reduction was particularly pronounced in P with left-sided AP (G I: 29,1 + 27,1 min, G II: 47,6 + 26,3 min, p=0.02) due to the rarer need for TSP.
Routine application of the LocaLisa© mapping-system for catheter ablation of accessory pathways can significantly reduce fluoroscopy exposure of patient and operator in daily practice without learning curve.
