The impact of steerable sheath visualization during catheter ablation for atrial fibrillation

Abstract

Aims Incorporating a steerable sheath that can be visualized using an electroanatomical mapping (EAM) system may allow for more efficient mapping and catheter placement, while reducing radiation exposure, during ablation procedures for atrial fibrillation (AF). This study evaluated fluoroscopy usage and procedure times when a visualizable steerable sheath was used compared with a non-visualizable steerable sheath for catheter ablation for AF. Methods and results In this retrospective, observational, single-centre study, patients underwent catheter ablation for AF using a steerable sheath that is visualizable using the CARTO EAM (VIZIGO; n = 57) or a non-visualizable steerable sheath (n = 34). The acute procedural success rate was 100%, with no acute complications in either group. Use of the visualizable sheath vs. the non-visualizable sheath was associated with a significantly shorter fluoroscopy time [median (first quartile, third quartile), 3.4 (2.1, 5.4) vs. 5.8 (3.8, 8.6) min; P = 0.003], significantly lower fluoroscopy dose [10.0 (5.0, 20.0) vs. 18.5 (12.3, 34.0) mGy; P = 0.015], and significantly lower dose area product [93.0 (48.0, 197.9) vs. 182.2 (124.5, 355.0) μGy·m2; P = 0.017] but with a significantly longer mapping time [12.0 (9.0, 15.0) vs. 9.0 (7.0, 11.0) min; P = 0.004]. There was no significant difference between the visualizable and non-visualizable sheaths in skin-to-skin time [72.0 (60.0, 82.0) vs. 72.0 (55.5, 80.8) min; P = 0.623]. Conclusion In this retrospective study, use of a visualizable steerable sheath for catheter ablation of AF significantly reduced radiation exposure vs. a non-visualizable steerable sheath. Although mapping time was longer with the visualizable sheath, the overall procedure time was not increased.

Initial experience with zero-fluoroscopy pulmonary vein isolation in patients with atrial fibrillation: single-center observational trial

“…In contemporary clinical practice, visualizable (by EAMS) steerable sheaths have become accessible. Their utilization demonstrates advantages in reducing fluoroscopy and facilitating the accomplishment of fluoroscopy-free AF ablations 16 , 17 .…”

Comparison of pulmonary vein isolation using cryoballoon, high-power short-duration, and conventional radiofrequency ablation for atrial fibrillation: a propensity score-weighted study

“…Steerable sheaths help the operators improve contact and stability of the ablation catheter, leading to achieve efficient lesion formation for AF ablation. Recently, with the advent of visualizable steerable sheaths, RF-PVI is associated with minimal radiation exposure ( 42 , 43 ), and zero-fluoroscopy RF-PVI ( 44 ) showed equal efficacy and safety compared with traditional procedures ( 45 ). Therefore, future direction for AF ablation using cryoballoon and radiofrequency catheter possibly studies better rhythm outcomes, lower complication rates, reduced procedure time, and also reduced radiation exposure.…”

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review

“…The employment of steerable catheters to improve ablation catheter handling and tissue contact, leading to reduced ablation time and high-quality lesions, is constantly increasing, particularly during pulmonary vein (PV) isolation [42]. The recent production of a new generation of steerable catheters that can be integrated with EAM systems and, therefore, visualized on the 3D map provided a significant optimization in the procedure workflow [43]. Their demonstrated use, compared to standard, non-visualizable catheters, further reduces the left atrial procedure time, RF delivery, and fluoroscopy exposure without compromising safety or effectiveness [44,45].…”