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

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.

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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)


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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