[Electroanatomical systems guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the EnSite-NavX and CARTO system].

OBJECTIVE: The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) and is becoming more widely accepted. This study aims to evaluate the effectiveness of the CARTO and the EnSite-NavX system and to compare between them on procedural parameters and clinical characteristics.

METHODS: Seventy-five patients with paroxysmal or persistent symptomatic AF were randomly assigned to CPVA procedure guided by either the EnSite-NavX system (group I, n = 40) or the CARTO system (group II, n = 35). After successful transseptal procedure, a geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferential tissues out of pulmonary veins (PVs) ostia. In cases with persistent AF, linear ablation was applied to modify the substrate of LA. The endpoint of the procedure was complete PVs isolation.

RESULTS: Seventy-four cases underwent a successful procedure. The total procedure and fluoroscopic time in group II was significantly shorter than those in group I (150 min +/- 23 min and 18 min +/- 17 min vs 170 min +/- 34 min and 25 min +/- 16 min, P = 0.03 and 0.04, respectively). There was no significant difference in the fluoroscopic and procedure durations for geometry creation between the groups I and II (8 min +/- 4 min and 16 min +/- 11 min vs 5 min +/- 4 min and 14 min +/- 8 min, respectively). The fluoroscopic time for CPVA was 15 min +/- 5 min in group I vs 10 min +/- 6 min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than those in group (86 min +/- 11 min vs 110 min +/- 15 min, P = 0.04). AF was terminated by RF delivery in 14 cases (35%) in group Ivs 5 cases (14%) in group II (P = 0.04). Complete PV isolation was obtained in 26 cases (65%) in group Ivs 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardial tamponade and 1 case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured and no PV stenosis was observed.

CONCLUSIONS: The CPVA procedure for atrial fibrillation is effective and safe. Although there is a difference between the CARTO and the EnSite-NavX system, the CPVA procedure guided by either of them yields similar clinical results.