From near‐zero to zero fluoroscopy catheter ablation procedures

Abstract

Aims The use of electroanatomical mapping (EAM) systems can reduce radiation exposure (RX) and it can also completely eliminate the use of RX. Radiation exposure related to conventional radiofrequency ablation procedures can have a stochastic and deterministic effect on health. The main aim of this study was to evaluate the safety and feasibility of an entirely nonfluoroscopic approach to catheter ablation (CA) using EAM CARTO3. Methods In 2011 we started an RX‐minimization programme in all procedures using the CARTO system with the deliberate intention to not resort to the aid of RX unless strictly necessary. We divided procedures into two groups (group 1: from 2011 to 2013; group 2: from 2014 to 2017). The only exclusion criteria were the need for transseptal puncture, and nonidiopathic ventricular tachycardia (VT). Results From a total of 525 procedures, we performed CA entirely without RX in 78.5% of cases. From 2011 to 2013, we performed CA without RX in 38.5% of cases; from 2014 to 2017, we performed 96.2% of cases with zero RX. The use of RX was significantly reduced in group 2 (group 2: 1.4 ± 19.6 seconds vs group 1: 556.92 ± 520.76 seconds; P < .001). These differences were irrespective of arrhythmia treatment. There were no differences between the two groups in acute success, complications, or duration of procedures. Conclusion CA of supraventricular tachycardia and VT entirely without RX, guided by the CARTO system, is safe, feasible, and effective. After an adequate learning curve, CA can be performed entirely without RX.

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

“…However, ultrasound provides only 2D visualization, which restricts its usage. In contrast, 3D mapping systems have been universally used for catheter ablation [ [7][8][9]. Under the direction of EAM, the tip of the transseptal needle can be visualized.…”

Catheter inversion during cavotricuspid isthmus catheter ablation: The new shaft visualization catheter reduces fluoroscopy use

“…The usage of ICE enabled direct visualization and a detailed assessment of the CTI anatomy. The ICE permitted to assess real contact between the tissue and the tip catheter, to improve the precision of the RF line with a merged isthmus and continuous monitoring of the pericardium and to prevent the “steam pop” showing the increased bubbles production during RF before that steam pop occurred 18,19 . Furthermore, anatomic CTI variations represented by the presence of a flat isthmus, pouch, long CTI, and prominent Eustachian ridge/valve have been shown to be the factors related to a longer RF duration 20 .…”

Zero‐fluoroscopy transseptal puncture guided by right atrial electroanatomical mapping combined with intracardiac echocardiography: A single‐center experience

“…Three-dimensional EAM has been used in association with catheter ablation for atrioventricular nodal reentrant tachycardia, cavotricuspid isthmus-dependent atrial flutter, and premature ventricular contraction, especially in pediatric and pregnant patients. [12][13][14][15][16][17] Three-dimensional EAM holds promise as a tool for use in combination with transseptal puncture.…”