Application of virtual navigation in the treatment of macro-re-entrant atrial tachyarrhythmias

Abstract

Macro-re-entrant atrial tachyarrhythmias occupy the leading positions in the structure of tachyarrhythmias, and one of the most common in this group is atrial flutter. These abnormal rhythms lead to a significant decrease in the quality of patients’ life, and sometimes, indirectly due to complications, can lead to disability and fatal consequences. Medical treatment for this group of arrhythmias has limited effectiveness, and the surgical method of treatment – catheter ablation – comes to the first place. Ablation of atrial flutter is traditionally performed under the guidance of fluoroscopy without the use of a navigation system, but this is associated with increased radiation exposure to patients and staff. Advances in modern arrhythmology make it possible to create anatomical models of heart chambers and activation models of the excitation spreading along anatomical models, reducing the radiation load, but requiring additional equipment and skills. Aim: to compare the procedure duration and radiation load during radiofrequency catheter ablation of the cavo-tricuspid isthmus using 3D navigation with traditional methods. Materials and methods. The work was based on the analysis of treatment results in 84 patients at National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. Depending on the imaging method, patients were divided into 2 groups. Group I included 31 patients who underwent radiofrequency cavo-tricuspid isthmus (CTI) ablation according to the traditional method under fluoroscopic control without using a navigation system. Group II comprised 27 patients in whom an anatomical model of the right atrium was created. Results. Success criteria were achieved in all groups, bidirectional block line was created at the level of the CTI. In group I, the average time from the first application to the restoration of sinus rhythm was 325 ± 25 s with an average number of applications of 7.4 ± 0.6 (from 5 to 10). The average procedure time was 43.0 ± 3.3 min, with an average X-ray time of 572 ± 44 s and an average dose area product (DAP) was 62.0 ± 5.0 Gy.cm2. In group II, the total duration of the first stage of the intervention was 312 ± 26 s. The average time to stopping tachycardia and restoring sinus rhythm was 230 ± 19 s. The average time from sinus rhythm restoration to confirmation of bidirectional CTI block was 71 ± 6 s with an average number of applications of 3.2 ± 3.0 per the procedure. The average procedure time was 41.5 ± 3.5 min, the average X-ray time was 120 ± 10 s, the average DAP was 15.0 ± 1.3 Gy.cm2. Conclusions. The usage of the anatomical model of the right atrium reduces X-ray exposure by 75.8 %, in comparison to the traditional technique, during radiofrequency catheter ablation of the cavo-tricuspid isthmus with similar procedure time. The anatomical model can be recommended for ablation of the cavo-tricuspid isthmus.