Fluoroless Atrial Fibrillation Catheter Ablation

Romero, Jorge; Patel, Kavisha; Briceño, David; Alviz, Isabella; Tarantino, Nicola; Rocca, Domenico G. Della; Natale, Veronica; Zhang, Xiaodong; Biase, Luigi Di

doi:10.1016/j.ccep.2020.01.001

Cited by 9 publications

(10 citation statements)

References 43 publications

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“…Although multiple studies have shown the benefits of ICE on radiation exposure in the past two decades [2,18,19], ICE still remains a controversial technique in present literature [20,21]. Over the last years, considerable efforts were made in order to achieve fluoroscopy doses following the ALARA principle as there is no magnitude of ionizing radiation exposure that is known to be completely safe [2].…”

Section: Discussionmentioning

confidence: 99%

“…Equally important, vulnerable populations, including children, pregnant woman and obese patients also present an increased risk of developing radiation side-effects [3,12,25]. ICE has been shown to reduce radiation exposure by lowering fluoroscopy time and dose during AF catheter ablation in experienced centres [2,4,5,9,20,21]. Furthermore, multiple studies have proven the feasibility of performing zero-or near-zero-fluoroscopy AF catheter ablation by combining 3D electroanatomical mapping systems with ICE [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…The total procedure times in our study were similar between the two groups (p>0.05). Multiple studies proved that ICE does not prolong total procedure time [10,18,21], some studies showing even a reduction in total procedure times by using ICE guidance [20]. Nevertheless, during zero-fluoroscopy AF ablation using ICE, Reddy et al [12] obtained higher total procedure times compared to simple pulmonary veins isolation, but authors admitted to intentionally spending more time for certain manoeuvres in their series.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, during zero-fluoroscopy AF ablation using ICE, Reddy et al [12] obtained higher total procedure times compared to simple pulmonary veins isolation, but authors admitted to intentionally spending more time for certain manoeuvres in their series. Despite ICE's increasing availability and growing use, fluoroscopy continues to be considered indispensable in many electrophysiology laboratories [21]. Fluoroscopy provides sufficient information for performing safe AF ablation in most cases, but variations in septal anatomy, aortic root dilatation, the need of multiple transseptal punctures and complex LA anatomy can make it inadequate [5,6].…”

Section: Discussionmentioning

confidence: 99%

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The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

Minciună

Puiu²,

Cismaru

et al. 2021

Med Ultrason

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Aims: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. Materials and methods: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. Results: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. Conclusions: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

Minciună

Puiu²,

Cismaru

et al. 2021

Med Ultrason

View full text Add to dashboard Cite

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“…According to the European society of cardiology guidelines, pulmonary vein isolation (PVI) should/may be considered as a first-line rhythm control therapy to improve symptoms in selected patients with symptomatic paroxysmal AF episodes (IIa), or persistent AF without major risk factors for AF recurrence as an alternative to antiarrhythmic drug class I or III, considering patient choice, benefit, and risk (IIb) [ 6 ]. Considering the worldwide spreading of this technique and the high exposure of radiation related to transseptal puncture and pulmonary vein isolation, promoting zero-fluoroscopy strategies in AF ablation is crucial to be in line with ALARA principles [ 4 , 7 , 8 ]. Nowadays, the use of fluoroscopy in radiofrequency ablation of AF is markedly reduced as compared to few years ago [ 9 ].…”

Section: State Of the Artmentioning

confidence: 99%

Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation

Bertini

Pompei

Tolomeo

et al. 2021

Biology

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Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.

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Steerable sheath visualizable under 3D electroanatomical mapping facilitates paroxysmal atrial fibrillation ablation with minimal fluoroscopy

Rajendra¹,

Hunter

Morales³

et al. 2022

J Interv Card Electrophysiol

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Background Advances in technology and workflows have facilitated substantial reductions in fluoroscopy utilization and procedure times for atrial fibrillation (AF) ablations. A recently available steerable sheath, visualizable on a 3D electroanatomical map (EAM), may further simplify low/zero fluoroscopy ablation workflows by facilitating understanding of the relative positions of the catheter and sheath. The objective of this study was to demonstrate feasibility, safety, procedural efficiency, and clinical effectiveness of incorporating the new visualizable sheath into a low-fluoroscopy workflow. Methods Consecutive de novo paroxysmal AF procedures were performed with a porous tip contact force catheter at a high-volume site between January 2018 and May 2019. Procedures performed with and without the VIZIGO™ EAM-visualizable sheath (Vizigo) were compared. All ablations employed the same standardized low-fluoroscopy workflow. Statistical analyses employed stabilized inverse probability of treatment weights (IPTW) to balance cohorts by operator and key patient characteristics. Results Cohorts of 142 Vizigo and 173 non-Vizigo patients were similar at baseline. Use of the Vizigo sheath was associated with approximately 10% improvement in catheter stability (p = 0.0005), 16% reduction in radiofrequency time (p < 0.0001), and 7% fewer ablations that used fluoroscopy (p = 0.0030). There was one cardiac tamponade in each cohort and no deaths, atrioesophageal fistulas, or strokes. Single-procedure freedom from atrial arrhythmia recurrence through 12 months was similar between cohorts (p = 0.9556). Conclusions Use of a 3D EAM-visualizable sheath resulted in improved catheter stability, reduced radiofrequency time, and more procedures performed without fluoroscopy, without compromise to safety or effectiveness.

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Fluoroless Atrial Fibrillation Catheter Ablation

Cited by 9 publications

References 43 publications

The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation

Steerable sheath visualizable under 3D electroanatomical mapping facilitates paroxysmal atrial fibrillation ablation with minimal fluoroscopy

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