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Europace Advance Access originally published online on April 7, 2009
Europace 2009 11(5):571-575; doi:10.1093/europace/eup069
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Atrial Fibrillation Registry

A randomized trial to compare atrial fibrillation ablation using a steerable vs. a non-steerable sheath

Kim Rajappan, Victoria Baker, Laura Richmond, Peter M. Kistler, Glyn Thomas, Calum Redpath, Simon C. Sporton, Mark J. Earley, Stuart Harris and Richard J. Schilling*

The Department of Cardiology, St Bartholomew’s Hospital and Queen Mary College, University of London, London EC1A 7BE, UK

Aims: Catheter positioning and stability are recognized challenges in catheter ablation of atrial fibrillation (AF). This prospective randomized study assessed whether routinely using a steerable sheath affects procedure outcomes.

Methods and results: Fifty-six AF patients were randomized to ablation using either an Agilis NXT (St Jude Medical, St Paul, MN, USA) steerable sheath or a fixed-curve Mullins sheath (Cook Medical Inc., Bloomington, IN, USA) for the ablation catheter. A mapping system with CT integration was used to isolate the pulmonary veins (PVs) in pairs and further ablation performed if AF persisted. There was no significant difference in time to gain trans-septal access, CT registration time, time to isolate PVs, fluoroscopy time for PV isolation, total procedure time, or total fluoroscopy time. A learning curve was seen for the steerable sheath, and after correcting for this, CT registration time and right PV isolation were quicker in this group. One patient crossed over from fixed-curve to steerable. Acute, 3-, and 6-month single procedure success were similar in both groups.

Conclusion: Allowing for the usage learning curve, a steerable sheath reduced time for some elements of AF ablation. Although this did not result in improved success, it may be useful for inexperienced operators, but at increased procedure cost.

Key Words: Catheter ablation, Atrial fibrillation, Sheath technology

* Corresponding author. Tel: +44 20 7601 8639, Fax: +44 20 7601 8627, Email: r.schilling{at}qmul.ac.uk

Manuscript submitted 24 November 2008. Accepted after revision 2 March 2009.


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A. Arya, G. Hindricks, P. Sommer, Y. Huo, A. Bollmann, T. Gaspar, K. Bode, D. Husser, H. Kottkamp, and C. Piorkowski
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Europace, November 3, 2009; (2009) eup331v1.
[Abstract] [Full Text] [PDF]


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