학술논문
High Efficiency Workflow During Atrial Fibrillation Ablation: Protocol and Experience with EnSite™ X EP System.
Document Type
Article
Source
Subject
*ATRIAL fibrillation
*CATHETER ablation
*ECHOCARDIOGRAPHY
*ELECTROPHYSIOLOGY
*BIOMEDICAL engineering
*MEDICAL care
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Language
ISSN
2831-7335
Abstract
Background: In recent years, there has been a dedicated focus to improve the tools, techniques, and technology for radiofrequency ablation (RFA) of atrial fibrillation (AF). Multi-electrode catheters paired with software enhancements for visualization and electrogram analysis have paved the way for more efficient mapping and anatomically accurate renderings of cardiac chambers. Contact force sensing catheters have been shown to be safe and effective tools for RFA, and software features have allowed for more accurate predictability of durable lesions. These factors combined can dramatically improve procedural outcomes. Objective: The authors sought to demonstrate a safe and efficient workflow for AF RFA using the EnSite™ X EP System, TactiCath™ Ablation Catheter, Sensor Enabled™ and Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ high-density mapping catheter. Methods: Forty-nine patients undergoing paroxysmal AF RFA procedures were studied retrospectively to evaluate efficiency and safety of a workflow designed to optimize mapping and ablation conditions. Anesthesia considerations were made to ensure proper accuracy during mapping and catheter stability during ablation. All patients were paralyzed after the right phrenic nerve was tagged and ventilation was kept at 25 breaths/min and a tidal volume of 250cc throughout the procedure. After double transseptal access was obtained, the ablation catheter was used to build VoXels for the entire left atrium (LA), which ensured better mapping accuracy with the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™. RFA was delivered using First Line Efficiency with EnSite™ X EP System (F.L.E.X.) protocol standards of power, time, impedance drop and AutoMark lesion tags. Results: This workflow has enabled our center to perform RFA AF procedures with procedural times of 74.20±17.84 minutes, radiofrequency ablation times of 10.35±3.47 minutes, zero-fluoroscopy in 97.9% of patients and same-day discharge for 76% of patients. There were no anesthesia or other procedural related complications. Conclusions: The recent enhancements of the EnSite™ X EP System with EnSite™ VoXel Mode magnetic navigation can be used with a detailed procedural workflow that optimizes mapping and ablation, yielding a safe and efficient RFA for AF. [ABSTRACT FROM AUTHOR]