Combined use of three-dimensional rotational angiogram of left atrium and circular multi-electrode ablation catheter for pulmonary vein isolation

Background A novel circular pulmonary vein ablation catheter(PVAC) has been introduced for pulmonary vein isolation(PVI).Accurate delineation of left atrium-pulmonary vein(LA-PV) anatomy is important for this technique.The aim of this study was to test whether the 3-dimensional rotational angiography(3D RTA) of the left atrium can facilitate PVI using PVAC technique. Methods Twenty patients with paroxysmal atrial fibrillation(AF) were enrolled in this study.The 3D RTA was reconstructed and registered with live fluoroscopy in all the patients.AF ablation was performed with a PVAC catheter in the navigation of registered 3D RTA. Results The 3DRTA image was successfully reconstructed and registered with live fluoroscopy in all patients(100%). The LA-PV anatomy was delineated clearly in all patients.Navigation of the PVAC inside the registered 3D RTA,ensured accurate placement within the atrium to perform ablation,and the PVAC was correctly placed inside the PV ostium to verify the PVI.All the PVs were isolated.Total procedural time was(87.5±12.1) minutes,and fluoroscopy time was (20.1±6.3) minutes.Follow-up after(7.1±1.5) months showed freedom from AF in 70%(14/20) patients.No PV stenosis was observed. Conclusions Intraprocedure reconstructed and registered 3D RTA can clearly delineate the LA-PV anatomy in real-time.The results demonstrate the feasibility and reliability of combining use of 3DRA and PVAC in AF ablation procedures.