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Observational Study
. 2023 Apr 15;25(4):1345-1351.
doi: 10.1093/europace/euad029.

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

Noel Fitzpatrick  1 , Ashish Mittal  1 , Joseph Galvin  1   2 , Gael Jauvert  1 , John Keaney  2   3 , Edward Keelan  1 , Jim O'Brien  1 , Gábor Széplaki  1   4
Affiliations
Observational Study

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

Noel Fitzpatrick et al. Europace. .

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.

Keywords: Atrial fibrillation; Catheter ablation; Fluoroscopy time; Radiation protection; Visualizable sheath.

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Conflict of interest statement

Conflict of interest: N.F. reports institutional educational support from Biosense Webster and Synapse Medical as well as speakers fees from Daiichi Sankyo, unrelated to the submitted work. G.S. reports personal fees from Abbott, Bayer, Boston Scientific, and Biosense Webster Inc. outside the submitted work. All remaining authors have declared no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Procedural data for patients treated using non-visualizable and visualizable sheaths. (A) Median mapping time, fluoroscopy time, and skin-to-skin time. (B) Fluoroscopy dose. (C) DAP. DAP, dose area product.
Figure 2
Figure 2
The distal portion of the VIZIGO visualizable sheath in its neutral position and in maximal bidirectional flexion. Note the four-ring electrodes, which allow for visualization of the sheath regardless of orientation or degree of flexion. Image courtesy of @Biosense Webster, Inc. All rights reserved. CARTO VlZlGO is a trademark of Biosense Webster, Inc.
See this image and copyright information in PMC

References

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