First experience of 3D rotational angiography fusion with NavX electroanatomical mapping to guide catheter ablation of atrial fibrillation

BackgroundRotational angiography of the left atrium with 3-dimensional reconstruction (3DATG) is a new imaging tool to guide atrial fibrillation (AF) ablation. Its role as part of a complex imaging strategy with NavX has not yet been evaluated.ObjectiveTo determine the feasibility of using 3DATG fusion with NavX in guiding AF ablation.Methods3DATG was performed in 24 consecutive patients undergoing AF ablation by using the Philips Allura Xper FD 10 system. The 3DATG anatomical shell was fused with NavX data (fusion group). Procedural characteristics of the fusion group were compared to 12 patients (control group) who underwent AF ablation guided by NavX only during the preceding 6 months.Results3DATG/NavX fusion was successful in all patients and required 12±2 fiducial points. Total radiation dose, fluoroscopy, and procedural times were significantly lower in the fusion group despite additional time and radiation exposure from 3DATG (total radiation dose of 20.4 mSv in the fusion group vs 34.0 mSv in the control group; P = .04; fluoroscopy time 50.5 minutes vs 69.7 minutes; procedural time 4.3 hours vs 5.1 hours). Ablation was successful acutely in 35 of 36 patients. At follow-up, 14 of 24 (58.3%) patients in the fusion group and 6 of 12 (50%) patients in the control group were in sinus rhythm. There was 1 complication in each group.ConclusionsAF ablation guided by 3DATG/NavX fusion is associated with reduced procedural time and radiation exposure and similar clinical outcomes when compared with NavX mapping only. 3DATG/NavX fusion may provide a lower radiation alternative to NavX only or preprocedural cardiac computed tomography as part of complex imaging strategies.