Atrial Fibrillation Ablation Without Fluoroscopy: Because We Can

Doshi, Rahul N.

doi:10.19102/icrm.2018.091103

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…The feasibility and safety of numerous fluoroless approaches for catheter-based pulmonary vein ablation and LA visualization have been demonstrated in smaller studies [ 7 ]. These include magnetic resonance imaging-guided ablation procedures [ 26 ], as well as intracardiac echocardiography [ 11 ] and transesophageal echocardiography [ 20 ] without any subsequent LA angiography.…”

Section: Discussionmentioning

confidence: 99%

“…However, this method is associated with a higher radiation burden to the patient [4,17]. The authors suggest implementing the following measures to ensure low radiation burden: The feasibility and safety of numerous fluoroless approaches for catheterbased pulmonary vein ablation and LA visualization have been demonstrated in smaller studies [7]. These include magnetic resonance imagingguided ablation procedures [26], as well as intracardiac echocardiography [11] and transesophageal echocardiography [20] without any subsequent LA an-giography.…”

Section: Minimizing Radiation During Left Atrial Angiographymentioning

confidence: 99%

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Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

Schreiber

Kähler

Biewener

et al. 2021

Herzschr Elektrophys

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Background Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry. Methods Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X‑ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration. Results The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation. Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography. Conclusion The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.

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Section: Discussionmentioning

confidence: 99%

Section: Minimizing Radiation During Left Atrial Angiographymentioning

confidence: 99%

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

Schreiber

Kähler

Biewener

et al. 2021

Herzschr Elektrophys

View full text Add to dashboard Cite

show abstract

“…With the comprehensive use of 3D anatomic mapping systems and intracardiac echo (ICE) imaging, fluoroless ablation with RF and CB is possible. Fluoroless ablation has been well described with RF energy 1–5 . Fluoroless ablation with CB, however, has not been widely performed because of the need to confirm occlusion of the pulmonary vein ostium with contrast dye injections and under fluoroscopy.…”

Section: Introductionmentioning

confidence: 99%

“…Fluoroless ablation has been well described with RF energy. [1][2][3][4][5] Fluoroless ablation with CB, however, has not been widely performed because of the need to confirm occlusion of the pulmonary vein ostium with contrast dye injections and under fluoroscopy. Advances with alternative imaging strategies and hemodynamic monitoring as a method of confirming pulmonary vein occlusion has been shown to reduce the need for fluoroscopy during ablation.…”

Section: Introductionmentioning

confidence: 99%

Step by step: How to perform a fluoroless cryoballoon ablation for atrial fibrillation

Alyesh

Frederick

Choe

et al. 2022

Cardiovasc electrophysiol

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Introduction Pulmonary vein isolation is the cornerstone of ablation of atrial fibrillation. With widespread use of 3D Electroanatomic Mapping Systems and advances in intracardiac echo imaging, fluoroless ablation has been possible. Methods Fluoroless ablation with cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. Results and Conclusion In this step‐by‐step guide, the authors will show how a CB ablation can be performed without the use of fluoroscopy.

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“…Fluoroless ablation using an RF energy source has been well-described, with a similar safety profile and outcomes as those of standard approaches. 1 – 5 Fluoroless ablation with CB, however, has not been widely performed because of the perceived need to prove circumferential occlusion of the PV ostium with fluoroscopic evaluation of contrast dye injections into the targeted vein.…”

Section: Introductionmentioning

confidence: 99%

Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation

Alyesh¹,

Venkataraman²,

A³

et al. 2020

J Innov Cardiac Rhythm Manage.

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Pulmonary vein isolation (PVI) is widely used for the ablation of atrial fibrillation, with prior reports suggesting good efficacy. Due to the widespread use of three-dimensional electroanatomic mapping systems and advances in intracardiac echocardiography, fluoroless ablation has been made possible. Fluoroless ablation with a cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. The objective of this study is to show that CB ablation can be performed safely and effectively without fluoroscopy. A dual-center, case–control study was performed of patients undergoing CB PVI with a fluoroless approach and a control group with traditional fluoroscopic techniques. The absence of color-flow Doppler signals around the periphery of the CB on intracardiac echocardiography and an increase in mean pressure by 5 mmHg, loss of the A-wave, and an increase in the V-wave as measured with continuous-wave pressure monitoring were adopted as indicators of vein occlusion in the absence of fluoroscopy. Temperature at 30 seconds, minimum temperature, time to isolation, procedure length, and complications were evaluated. During the study period of November 15, 2018 to November 15, 2019, a total of 100 patients underwent CB PVI at the participating centers. A total of 50 patients were enrolled in the fluoroless arm [35 men (70%), mean age: 64.9 ± 12 years, mean left atrium size: 44.2 ± 16 mL/m 2 , left ventricular ejection fraction: 61% ± 5%], while 50 patients were enrolled in the control arm with similar characteristics. Four hundred forty-one 441 PVs were evaluated in the study cohort compared to 339 PVs in the control arm. When comparing fluoroless and traditional techniques, the mean temperature at 30 seconds was −31.7°C ± 6°C versus −32.8°C ± 5°C (p = 0.037), the minimum temperature was −47.4°C ± 6°C versus −47.7°C ± 9°C (p = 0.677), the time to isolation was 56.8 ± 28 seconds versus 74.8 ± 45 seconds (p = 0.212), and the procedure time was 102.2 ± 27.3 seconds versus 104.5 ± 16.9 seconds (p = 0.6436). Ultimately, t his proof-of-concept study revealed that fluoroless ablation can be performed with success and efficiency outcomes similar to those of a traditional ablation approach. This suggests that the ablation of atrial fibrillation with CB can be performed safely and effectively without the use of fluoroscopy by experienced operators.

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Atrial Fibrillation Ablation Without Fluoroscopy: Because We Can

Cited by 4 publications

References 24 publications

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

Step by step: How to perform a fluoroless cryoballoon ablation for atrial fibrillation

Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation

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