|
Catheter Ablation of Atrial Fibrillation: How to Balance between a Lot of Technology and Common Sense
|
|
|
|
 |
|
Catheter Ablation of Atrial Fibrillation: How to Balance between a Lot of Technology and Common Sense
Josef Kautzner, MD, PhD, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Catheter ablation of atrial fibrillation (AF) is a complex procedure with significant learning curve for the operator and risk of potentially serious complications for the patient. They both are exposed to increased radiation dose.
To make the procedure more standardized and efficacious, two remote navigation systems have been developed. Our experience with electromechanic robotic system (Hansen Medical) documents significant shortening of the procedure and fluoroscopic time without sacrificing safety. Analysis of more than 5 months follow-up suggests increased efficacy (92 % of patients after ablation of paroxysmal AF is asymptomatic, 75 % without any documented episode of AF after the first ablation procedure). |
Another option to improve efficacy and decrease potential complications is the use of 3D mapping systems. Available systems allow integration with CT or MR angiography scans and appear to help with navigation of ablation catheter with little need for fluoroscopy.
In order to maximize safety, intracardiac echocardiography can be used to guide the procedure. It has a potential to make very safe transseptal puncture, display ostia of all pulmonary veins and avoid risk of post-ablation stenosis, minimize risk of thromboembolic complications and esophageal injury. It also allows early recognition of serious complications such as cardiac tamponade.
Every center has to make own decision which technology is helpful, and what degree of benefit it brings in an exchange for increased cost.
 
 
 
 
|