Comparison of safety and effectiveness of different sheaths in ablation of focal atrial tachycardia: a retrospective study

Min Xie; Dingming Liu; Ruikun Jia; Yixuan Bai; Juan Chan; Zhongyun Lin; Paul Khairy; Kaijun Cui

doi:10.21037/jtd-24-52

Comparison of safety and effectiveness of different sheaths in ablation of focal atrial tachycardia: a retrospective study

J Thorac Dis. 2024 Mar 29;16(3):2011-2018. doi: 10.21037/jtd-24-52. Epub 2024 Mar 27.

Authors

Min Xie^{1

2}, Dingming Liu¹, Ruikun Jia¹, Yixuan Bai¹, Juan Chan¹, Zhongyun Lin¹, Paul Khairy³, Kaijun Cui¹

Affiliations

¹ Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
² Department of Cardiology, Chengdu Seventh People's Hospital, Chengdu, China.
³ Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada.

Abstract

Background: A novel visualized steerable sheath, referred to as the Vizigo sheath, has been utilized in clinical interventions. The objective of this study was to evaluate and contrast the efficacy and safety of the Vizigo sheath with other sheaths in the catheter ablation (CA) for focal atrial tachycardia (FAT).

Methods: A retrospective cohort study was conducted on consecutive patients with CA for FAT from March 2019 to February 2022. Objectives were to assess the impact of the Vizigo sheath on acute and long-term ablation success rates, procedural and fluoroscopy times, and contact force (CF).

Results: A total of 164 patients, mean age 50±15 years, 97 (59.1%) women, underwent CA of FAT using the Vizigo sheath (N=42), non-visualized steerable sheath (N=36), or other conventional sheath (N=86). Age, sex, body mass index (BMI), presence of hypertension, heart failure, and diabetes mellitus were not significantly different among the three groups. The acute success rate of 94.0% was similar among the three groups. Over a follow-up of 14±2 months, the Vizigo sheath was associated with superior arrhythmia-free survival (88.1%) when compared to non-visualized steerable (69.4%; P=0.04) and other conventional (72.1%, P=0.046) sheaths. Procedural duration, number of ablation lesions, and ablation times were similar among the three groups. However, the Vizigo sheath was associated with lower fluoroscopy times (e.g., 145 vs. 250 s with Vizigo versus non-visualized steerable sheaths, P=0.03) and higher CF (e.g., average CF 12.0 versus 8.0 g with Vizigo versus non-visualized steerable sheaths, P=0.003).

Conclusions: The application of Vizigo sheath can improve the long-term success rate of FAT and reduce the radiation exposure of patients and medical staff in our single-center limited sample study. More research may be needed in the future to confirm our findings.

Keywords: Focal atrial tachycardia (FAT); catheter ablation (CA); contact force (CF); fluoroscopy time; visualized steerable sheath.