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Europace Advance Access originally published online on June 18, 2009
Europace 2009 11(8):1004-1010; doi:10.1093/europace/eup152
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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.

Ablation for Atrial Fibrillation

Image integration increases efficacy of paroxysmal atrial fibrillation catheter ablation: results from the CartoMergeTM Italian Registry

Emanuele Bertaglia1,*, Paolo Della Bella2, Claudio Tondo3, Alessandro Proclemer4, Nicola Bottoni5, Roberto De Ponti6, Maurizio Landolina7, Maria Grazia Bongiorni8, Leonardo Corò9, Giuseppe Stabile10, Antonio Dello Russo3, Roberto Verlato11, Massimo Mantica12 and Franco Zoppo1

1 Ospedale Civile di Mirano, Via Mariutto, 13-30035 Mirano, Italy; 2 Centro Cardiologico Monzino, Milan, Italy; 3 Ospedale Civile San Camillo-Università Cattolica del Sacro Cuore, Rome, Italy; 4 Azienda Ospedale/Università Santa Maria della Misericordia, Udine, Italy; 5 Ospedale Santa Maria Nuova, Reggio Emilia, Italy; 6 Università dell'Insubria-Ospedale di Circolo, Varese, Italy; 7 Policlinico S. Matteo, Pavia, Italy; 8 Ospedale Cisanello, Pisa, Italy; 9 Ospedale Civile di Conegliano, Treviso, Italy; 10 Casa di Cura S. Michele, Maddaloni Caserta, Italy; 11 Ospedale Civile di Camposampiero, Padova, Italy; 12 Istituto Clinico Sant'Ambrogio, Milan, Italy

Aims: The aim of this study was to investigate whether circumferential pulmonary vein (PV) isolation guided by image integration improves the procedural and clinical outcomes of atrial fibrillation (AF) ablation in comparison with segmental PV isolation and circumferential PV isolation guided by three-dimensional (3D) electroanatomical mapping alone.

Methods and results: Procedural and clinical outcomes of 573 patients who underwent their first catheter ablation for paroxysmal AF between January 2005 and April 2007 were collected from 12 centres. We evaluated three techniques: segmental ostial PV isolation (SOCA group, 240 patients), circumferential PV isolation guided by electroanatomical mapping (CARTO group, 107 patients), and circumferential PV isolation guided by electroanatomical mapping integrated with magnetic resonance/computed tomographic images of the left atrium (MERGE group, 226 patients). Procedure duration proved to be shorter in MERGE group patients than in CARTO group patients (P < 0.04), but longer than in SOCA group patients (P < 0.0001). During follow-up, atrial tachyarrhythmias relapsed more frequently in SOCA group patients (44.6%) and CARTO group patients (41.7%) than in MERGE group patients (22.6%; P < 0.0001).

Conclusion: In patients with paroxysmal AF, circumferential PV isolation guided by image integration significantly improves clinical outcome in comparison with both circumferential PV isolation guided by 3D mapping alone and with segmental electrophysiologically guided PV isolation.

Key Words: Atrial fibrillation, Catheter ablation, Image integration, Three-dimensional mapping systems

* Corresponding author. Tel: +39 0415794253, Fax: +39 0415794309, Email: bertagliaferro{at}alice.it

Manuscript submitted 1 February 2009. Accepted after revision 19 May 2009.


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B. D. Powell and D. L. Packer
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