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Steerable Versus Nonsteerable Sheath Technology in Atrial Fibrillation Ablation: A Prospective, Randomized Study
Study Questions:
Does the use of a steerable sheath improve outcomes after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?
Methods:
One hundred twenty-three patients (mean age 59 years) were randomly assigned to undergo RFCA of AF (paroxysmal in 64%) using either a steerable sheath (n = 63) or a conventional nonsteerable sheath (n = 60). The ablation strategy was pulmonary vein isolation by circumferential ablation in all patients and additional linear ablation in patients with persistent AF. Efficacy was assessed with 7-day Holter monitors at 3 and 6 months. The primary endpoint was freedom from AF at 6 months.
Results:
A significantly larger proportion of patients were free of AF at 6 months in the steerable sheath group (76%) than in the conventional sheath group (53%). Eighteen percent of patients were taking a rhythm-control drug at 6 months, with no difference between the two groups. The mean procedure time was approximately 170 minutes in both groups. The mean fluoroscopy time was significantly shorter in the steerable sheath group (33 vs. 45 minutes). The complication rates in the steerable sheath group (3.2%) and the conventional sheath group (5%) did not differ significantly.
Conclusions:
The authors concluded that use of a steerable sheath improves the 6-month success rate after RFCA of AF without increasing the risk of a complication.
Perspective:
Steerability allows the sheath to be positioned near a target site with only 2-3 cm of the ablation catheter protruding from the sheath. This improves tissue contact and stability of the ablation catheter at target sites, resulting in larger ablation lesions. However, because of the stiffness of the system, great care is needed to avoid atrial perforation.
Keywords: Fluoroscopy, Pulmonary Veins, Atrial Fibrillation, Electrocardiography, Catheter Ablation
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