Impact of respiration gating on image integration guided atrial fibrillation ablation

Radiofrequency (RF) catheter ablation guided by electroanatomic mapping systems is an effective therapy for atrial fibrillation. However, it may be affected by respiration movements. The aim of this study was to determine the impact of respiratory gating on procedural parameters in patients undergoing catheter ablation of atrial fibrillation (AF).

One-hundred forty consecutive patients undergoing pulmonary vein isolation were admitted to study. Respiratory gating module (AccuResp algorithm, Carto3, Biosense Webster) was enabled in 70 patients and disabled in 70 patients during procedures. Successful pulmonary vein isolation and sinus rhythm were obtained in all patients. A significant reduction in total procedure times [median 77, interquartile range (IQR 66–95) min vs median 82 (IQR 72–104) min, p < 0.05] and fluoroscopy times [median 14 (IQR 9–17) min vs median 16 (IQR 12–22) min, p < 0.05] were observed in the respiratory gated group. Although ablation times (duration between the first and last ablation) were significantly shorter in respiratory gated group [median 37 (IQR 32–53) min vs median 48 (IQR 39–65) min, p < 0.05], total RF application durations were not different between two groups [median 1,554 (IQR 1,213–2,196) s vs median 1,802 (IQR 1,344–2,448) s, p = 0.11]. Difference in electroanatomical map reconstruction times was not significant [median 14 (IQR 12–16) min in gated group vs median 13 (IQR 10–18) min in nongated group, p = 0.19].

Respiratory gating significantly improves fluoroscopy and ablation times during electroanatomic mapping guided AF ablation. Respiratory gated maps may provide uninterrupted continuous ablation applications. Furthermore, using automatic respiratory gating module does not prolong mapping times.