A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation
EP Europace ,
Aug 2015
Arujuna, Aruna , Karim, Rashed , Zarinabad, Niloufar , Gill, Jaspal , Rhode, Kawal , Schaeffter, Tobias , Wright, Matthew , Rinaldi, C. Aldo , Cooklin, Michael , Razavi, Reza , et al.
Arujuna, Aruna
Karim, Rashed
Zarinabad, Niloufar
Gill, Jaspal
Rhode, Kawal
Schaeffter, Tobias
Wright, Matthew
Rinaldi, C. Aldo
Cooklin, Michael
Razavi, Reza
et al.
To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes.
A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation
Europace
A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation
Aruna Arujuna 0 1
Rashed Karim 0
Niloufar Zarinabad 0
Jaspal Gill 0
Kawal Rhode 0
Tobias Schaeffter 0
Matthew Wright 0 1
C. Aldo Rinaldi 0 1
Michael Cooklin 1
Reza Razavi 0 1
Mark D. O'Neill 0 1
Jaswinder S. Gill 0 1
0 Division of Imaging Sciences and Biomedical Engineering, King's College London , St. Thomas
1 Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust , London , UK
Aims To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods Forty paroxysmal atrial fibrillation patients (mean age 54 + 13.8 years) undergoing first left atrial ablation were randoand results mized to either robotic-assisted navigation (Hansen Senseiw X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P ? 0.002) and 76%(P ? 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P ? 0.04). At 6 months follow-up, arrhythmiafree patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P ? 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P ? 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P , 0.001) in the standard to achieve a success rate of 80% vs. 75%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Introduction
Arrhythmia recurrences following pulmonary vein isolation (PVI)
in paroxysmal atrial fibrillation (PAF) are almost universally
associated with electrical reconnection between the left atrium (LA)
and pulmonary veins (PVs).1 Acute PV electrical isolation achieved
following energy delivery to the left atrial-pulmonary vein (LA-PV)
junction or antrum2 does not always translate into long-term clinical
success, with only 50 ? 60% of patients being cured following a single
procedure.3,4 The formation of a durable permanent transmural scar
What?s new?
? This is the first cardiac magnetic resonance (CMR) study
performed to prospectively compare the effect of robotic and
standard catheter ablation by late gadolinium enhancement
and evaluate the findings in relation to 6 month and 3 year
clinical outcome.
? Robotic-assisted ablation results in greater percentages of
permanent pulmonary vein (PV) encirclement quantified on
CMR, suggesting better catheter contact and stability.
? A significantly less LGE signal regression from acute to late
scan in the robotic recurrences group suggests that acute
energy delivery with this approach produces more durable
lesions.
? A significantly lower number of re-do procedures was
observed in the robotic group over the mean 3 years clinical
follow-up period.
? These data represent the first CMR evidence in man that
robotic-assisted ablations create more efficacious ablation
lesions than a standard manual approach.
is critical to block electrical conduction between the LA and PVs and
to prevent spontaneous PV ectopics from triggering AF.
Over the (...truncated)
This is a preview of a remote PDF: https://academic.oup.com/europace/article-pdf/17/8/1241/7112637/euu364.pdf
Arujuna, Aruna, Karim, Rashed, Zarinabad, Niloufar, Gill, Jaspal, Rhode, Kawal, Schaeffter, Tobias, Wright, Matthew, Rinaldi, C. Aldo, Cooklin, Michael, Razavi, Reza, O'Neill, Mark D., Gill, Jaswinder S..
A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation ,
EP Europace,
2015, pp. 1241-1250, Volume 17, Issue 8, DOI: 10.1093/europace/euu364