Abstract 3228: Feasibility and Limitations of “Automatic” Mapping and Pre-Designed Computer Assisted Ablation of Atrial Fibrillation Using the Stereotaxis Navigation System
Introduction: Combination of magnetic catheter guidance and electroanatomic (EA) mapping may provide additional capability for the automated ablation of advanced arrhythmias. Nevertheless, automatic mapping and computer assisted ablation algorithms have not been quantitatively validated.
Methods: The outcome of computer based interventions was therefore assessed in 14 patients undergoing atrial fibrillation (AF) ablation at Mayo. Pulmonary veins and left atrium (LA) were mapped under automatic sampling or directed operator guidance using the Stereotaxis system. Ablation strategies for WACA were then designed on the electoanatomic map framework, downloaded to the Sterotaxis system and tested for ablation.
Results: Fourteen patients with AF underwent ablation (age of 59 ± 8 years). The stereotaxis system was successful in navigating to and geometric rendering of 56 of 56 (100%) of the PV’s, the majority of which were volume rendered using automatically varying magnetic vectors. 20 PV’s in 5 patients were successfully “auto mapped” using a “bulls-eye” approach driven exclusively by the magnetic system. In 4 cases, for a total of 16(29%) of the PVs, ablation automatic algorithms were converted to manual ablation mode, 1 case for a navigational system failure, another case due to catheter manipulation problems, and 2 cases due to impedence rises seconday to char formation. Navigation for circumferential ablation of the PV’s was successfully completed in 40 (71%) of the veins. The PVs were completely isolated in 23 (58%), while touch-up ablation was required in 17 (42%) of veins. Mitral isthmus lines were employed in 6 cases with 4/6 (66%) requiring irrigation tip touchups to achieve bidirectional block. Mean procedure, fluoroscopy, and ablation times were 425.2 ± 56.8, 82.5 ± 23.1, and 220 ± 36.3 minutes, respectively.
Conclusion: These data demonstrate the feasibility of automatic Sterotaxis driven navigation and mapping with computer assisted automated ablation algorithm for atrial fibrillation. Nevertheless, procedural success is substantially limited by the available 4mm tip ablation catheters.