The National Heart Foundation of Australia Consensus Statement on Catheter Ablation as a Therapy for Atrial Fibrillation

Background: In general is it believed that use of a deflectable sheath can enhance tissue contact or improve catheter manipulation for ablation of challenging cavotricuspid anatomy. We sought to determine if use of a St. JudeAgilis sheath®− lead to improvedcontact force, faster procedures or greater efficacy in typical right atrial flutter ablation. Method: We performed cavotricuspid isthmus ablation with a pressure sensing catheter on 20 patients with isthmus dependant flutter and randomised them to use, or no use of an Agilis sheath. For the purpose of contact force assessment, the isthmus was divided into peri-annular, mid isthmus and venacaval zones. The proceduralist was blinded to contact force readings and the end point of ablation was bidirectional isthmus block with >50% prolongation of the transisthmus interval. Results: After 10min of ablation, four patients in the control group crossed over to use of an Agilis sheath. On intention to treat analysis bidirectional isthmus block was achieved in 9/10 patients with use of the Agilis sheath and 10/10 patients without (p=NS). Results were as follows.