IJBEM, Vol. 4, No. 2, 2002.

THREE DIMENSIONAL CATHETER POSITIONNING DURING
RADIOFREQUENCY ABLATION IN PATIENTS WITH
ATYPICAL FLUTTERS ON SCARE.

A.Pisapia¹, J.Faure¹, M. Bremondy¹, A.Ferracci¹, G. Duport¹
¹Service de Cardiologie, Hôpital Saint-Joseph
26 bd de Louvain – 130008 Marseille – FRANCE.

INTRODUCTION

Precise localization of target sites for radiofrequency catheter ablation (RFCA) is hampered by the relative inaccuracy of X-ray localisation procedures in a three dimension-cavity. As the localization of the scare and the precise mechanism of the tachycardia are difficult to perform, atypical flutters on scare represent atrial arrythmias with enter in this field.

METHODS

From January 97 to April 2001, 13 patients (age : 50,3 ± 8 years) presenting and atypical flutter on scare have undergone a three dimensional (3D) endocardial mapping and a RFCA by the Biosense Carto system.In 10 cases,the morphology of the flutter’s wave was ± in II, III, VF, - in I, VL. The average lenght of the FF cycle was 342.72 ± 90.5 ms. In 8 cases, surgery had corrected on atrial septal defect associated once to a pulmonary stenosis, in one case an endocardial cushion defect, and in another case a mitral valvular disease. The number of antiarrythmic agents (AA) prescribed before the ablation was : 1.5/patient. The procedure is performed under local anesthesia, with an average lenght of 88 ±12.3 mn.

RESULTS

Among 13 patients, 12 had a restauration of sinus rythm during the procedure. One procedure had to be stopped because of vagal symptoms, with strong hypotension. In the 21 ± 5.9 months follow-up, 1 recurrence occurred within 6 months. A second procedure was not performed because of the refusal of the patient. The other patients are in sinus rythm without AA treatment and 4 patients with an AA treatment.

DISCUSSION

The 3D system of endocardial mapping used in this study allows accurate 3D positionning of ablation catheter and marking of ablation sites. The proportion of success during procedure and of sinus rythm in the follow up is superior to the one obtained with classical methods.