Use of ColumbusTM, a new three-dimensional cardiac electrophysiological mapping system in catheter ablation of atrial fibrillation

Objective To investigate the efficiency of ColumbusTM, a new three-dimensional cardiac electrophysiological mapping system in the ablation of persistent atrial fibrillation (AF). Methods Consecutive patients with persistent AF uncontrolled on medications in our hospital between October 2012 and October 2013 were included in this study. Before the operation, all patients received oral warfarin for effective anticoagulation for at least 3 weeks, and underwent transesophageal echocardiography and cardiac CT to exclude intracardiac thrombus. The antiarrhythmic agents other than amiodarone were discontinued at least 5 days before the operation. The three-dimensional cardiac electrophysiological mapping system ColumbusTM was used to create a point cloud (≥20 points) to establish the three-dimensional anatomical model of the left atrium and pulmonary veins. The shortest distances between points and their corresponding image on CT were calculated to evaluate the accuracy of the left atrium model. All the patients underwent procedures ranging from circumferential pulmonary vein ablation (CPVA) to pulmonary vein isolation (PVI) , and with auxiliary linear ablation. The left atrial modeling time, PVI time, operation time, and X-ray exposure time were recorded. The safety and efficacy of the ablation were evaluated during the one-year follow-up after the operation. Results Seven patients with persistent AF were included in this study. The left atrial models were successfully established in all patients by using ColumbusTM system, and the left atrial volume was (111.1± 29.9) ml. The registration error between the geometric left atrial model by ColumbusTM system and the CT left atrial model was (1.99±0.51) mm. All the patients underwent CPVA, and the ablation of mitral isthmus and the top of left atrium. Three patients underwent the ablation of tricuspid isthmus at the same time. All patients achieved intraoperative PVI, and bidirectional block of linear ablation. The operation time, left atrial modeling time, PVI time, and X-ray exposure time was (185.9±42.1) min, (14.0±4.6) min, (96.9±46.3) min, and (27.3±11.2) min, respectively. At 1 year of the postoperative follow up, no operation-related complications was found in all patients. One patient suffered recurrence of AF; the remaining 6 were stable on sinus rhythms without using antiarrhythmic drugs. Conclusion The ColumbusTM three-dimensional cardiac electrophysiological mapping system can accurately establish three-dimensional anatomical model of the atria, which is safe and effective for guiding the ablation for persistent AF. Key words: ColumbusTM system; Atrial fibrillation; Catheter ablation