Efforts to enhance catheter stability improve atrial fibrillation ablation outcome

Background: Contemporary techniques to enhance anatomical detail and catheter contact during atrial fibrillation (AF) ablation include (1) the integration of preacquired tomographic reconstructions with electroanatomical mapping (3-dimensional image integration [I-EAM]), (2) the use of steerable introducers (SIs), and (3) high-frequency jet ventilation (HFJV). Objective: To prove that using these stabilizing techniques during AF ablation improves 1-year procedural outcome. Methods: We studied 300 patients undergoing AF ablation at our institution. Patients were divided into 3 equal treatment groups (100 patients each) on the basis of the tools utilized: (1) group 1: AF ablation performed without I-EAM, SI, or HFJV; (2) group 2: AF ablation performed using I-EAM and SI, but without HFJV; and (3) group 3: AF ablation performed with I-EAM, SI, and HFJV. The primary outcome was freedom from AF 1 year after a single ablation procedure. The burden of both acute and chronic pulmonary vein reconnection was also assessed. Results: Patients from groups 2 and 3 had significantly more nonparoxysmal AF (17% vs 30% vs 39%; P =.002), larger left atria (4.2±0.8 cm vs 4.4±0.7 cm vs 4.5±0.8 cm; P<.001), and higher body mass index (BMI; 28.5±5.8 kg/m² vs 29.1±4.8 kg/m² vs 31.2±5.4 kg/m²; P<.001). Despite these differences, with adoption of I-EAM, SI, and HFJV we noted a significant improvement in 1-year freedom from AF (52% vs 66% vs 74%; P =.006) as well as fewer acute (1.1±1.2 vs 0.9±1.1 vs 0.6±0.9; P =.03) and chronic (3.5±0.9 vs 3.2±0.9 vs 2.4±1.0; P =.02) pulmonary vein reconnections. Conclusions: The incorporation of contemporary tools to enhance anatomical detail and ablation catheter stability significantly improved 1-year freedom from AF after ablation.