Optimalisatie van pulmonaal venen isolatie door ‘grid’ visualisatie

Randomized prospective intervention study, comparing grid visualization to point-by-point visualization of ablation lesions during pulmonary vein isolation.

Freedom of atrial fibrillation (AF) after pulmonary vein isolation (PVI) is limited to 50-80% of patients, dependent on patient characteristics. This is typically due to electrical reconnection between the pulmonary veins and the left atrium at follow-up. Efforts to optimize outcome of catheter ablation for AF should therefore be directed towards creation of complete and lasting lesion circles.

The Carto 3D mapping system allows 3D visualisation of a cardiac chamber by fast anatomical mapping using intracardiac catheters. During PVI, an outline (‘shell’) of the left atrium is created on which the location of ablation can be manually annotated.

The new ‘Visitag’ module of the Carto 3D mapping system allows automated visualization of the precise site of ablation using a grid that is displayed on the 3D shell of the mapped cardiac chamber. In addition, it shows the amount of radiofrequency (RF) time for each specific grid point. Displaying the grid may provide a superior visual feedback for the operator on continuity of ablation lines and stability of the catheter, compared to single dot visualization by manual or automatic tagging. As a result it may improve procedure times and outcomes of catheter ablation of atrial fibrillation.

1 year - freedom from atrial fibrillation

Patients will be randomized to either encircling pulmonary veins using the automated point-by-point annotation (ablation index) or encircling pulmonary veins using the grid annotation.