Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5‐Year Experience

Abstract

(PACE 2017; 40:425-433) ablation, arrhythmia, fluoroless

Outcomes of 200 consecutive, fluoroless atrial fibrillation ablations using a new technique

“…Most other studies on fluoroless AF ablation are either small scale or were performed at a low volume (Table ). The only study that included more than 100 fluoroless AF ablations was performed over 5 years by multiple operators at a volume of ≤ 40 per year and required an average procedure time of 194 minutes versus 106 minutes in this study (Table ) . It may not be practical to implement these ablation approaches in a busy, high‐volume EP lab.…”

“…Another important but often overlooked and understudied aspect of any ablation method involves the cost effectiveness. More recently, several studies have been reported, aiming to minimize or eliminate radiation exposure . However, none of these studies addressed the issue of cost effectiveness.…”

“…Recently, studies have emerged to use minimal or zero fluoroscopy during AF ablation (Table ). The procedural protocol in these studies required detailed 3D mapping with creation of left atrial geometry, costly mapping catheters, as well as increased total procedure time including left atrial dwell time . In addition, most of these studies included a relatively small number of fluoroless ablations and there is a paucity of information in the literature regarding the cost‐effectiveness of these new ablation approaches.…”

“…The procedural protocol in these studies required detailed 3D mapping with creation of left atrial geometry, costly map-ping catheters, as well as increased total procedure time including left atrial dwell time. [5][6][7][8][9][10][11] In addition, most of these studies included a relatively small number of fluoroless ablations and there is a paucity of information in the literature regarding the cost-effectiveness of these new ablation approaches. It is also not clear whether completely fluoroless AF ablation can be performed efficiently and safely on a routine basis in a busy, nonacademic EP lab, including patients with intracardiac leads from implantable devices.…”

Let go to grow: Reconciling your dependence on fluoroscopy for atrial fibrillation ablations

“…In the two largest studies, the current study by Liu and Palmer and another from Razminia et al, (n = 186) complication rates were 1–1.6%. The study by Razminia et al also included 36 patients with cryothermal balloon ablation …”