Comparative study of electroanatomical and conventional mapping and catheter ablation of atrial tachyarrhythmia

Objective To assess the clinical benefits of electroanatomically guided mapping and radiofrequency ablation under Carto system for atrial tachyarrhythmia by comparison to conventional method. Methods Twenty seven patients with atrial tachyarrhythmia were included. The conventional method was applied to 15 cases as control group. Three dimensional electroanatomical map of the atrium of interest was created using Carto system during tachycardia in 12 cases as the Carto group. The success rate, the operation time, the fluoroscopic time, the complications and the follow up findings were compared between two groups. Results In control group,there were 9 cases with atrial tachycardia(AT) in right atrium and 6 with typical atrial flutter(AF).Among them 13 cases had instantaneous successful ablation. In Carto group, all 12 cases (6 with AT, including 2 after surgical operation ,5 with typical AF, 1 with typical AF in left atrium) had instantaneous successful ablation. Two cases with unsuccessful ablation (1 with AT after surgical correction of Fallot′s trilogy, 1 para hisian AT ) in the control group underwent another successful ablation session under the guide of Carto system mapping. Comparing the Carto group with the control group, the fluoroscopic time was shorter [(16±7) min vs. (37±19) min, P 0.01], but the operation time was longer [(236±53) min vs. (179±67) min, P 0.05]. No complication occured in both groups. After follow up of 4-8 months, one patient with AT in left atrium in the Carto group recurred and underwent another ablation under Carto system with a successful result. Conclusions This study suggests that electroanatomically guided mapping and ablation of atrial tachyarrhythmia is more efficient than conventional method, especially apparent in the decrease of flouroscopic time. The Carto electroanatomical mapping system displays three dimensional anatomical information with electrical information related to signal amplitude and activation time. It simplifies the mapping of arrhythmia localization, ?and facilitates recognition of target site of ablation and assessment of linear lesion continuity, especially in some complicated cases such as congenital heart disease after operation.