Nonfluoroscopic three-dimensional mapping for arrhythmia ablation: Tool or toy?

Arrhythmia Ablation with Nonfluoroscopic 3D Mapping. Introduction: Conventional mapping and ablation rely on fluoroscopy, which can result in imprecise positioning of the ablation catheter and long fluoroscopic exposure times. We evaluated a nonfluoroscopic three-dimensional mapping system, termed CARTO, and compared the results of ablation using this technique with those of conventional mapping. Methods and Results: We compared the results of 88 arrhythmia ablations (79 patients) using CARTO with 100 ablations (94 patients) using the conventional technique. The ablations mere separated into four groups: (1) AV nodal reentrant tachycardia (AVNRT); (2) atrial tachycardia/ flutter; (3) ventricular tachycardia (VT); and (4) bypass tract tachycardia. We compared the success rate, complications, and fluoroscopy and procedure times. The ablation outcomes were excellent and comparable in all four types of the arrhythmias between the two techniques. Major complications included one cardiac tamponade in each group and one second-degree AV block in the conventional group. Fluoroscopy time was shorter using the CARTO technique: 10 +/- 7 versus 27 +/- 15 minutes for AVNRT (P < 0.01), 18 +/- 17 versus 44 +/- 23 minutes for atrial tachycardia and flutter (P < 0.01), 15 +/- 12 versus 34 +/- 31 minutes for VT (P < 0.05), and 21 +/- 14 versus 53 +/- 32 minutes for bypass tract tachycardia (P < 0.01). Procedure times were similar except for the bypass tract patients, which was shorter in the CARTO group, 4 + 1.3 versus 5.5 +/- 2.5 hours (P < 0.01). Conclusion: The electroanatomic three-dimensional mapping technique reduced fluoroscopy time and resulted in excellent outcome without increasing the procedure time.