Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation

Abstract

We have shown a significant decrease in multiple measures of radiation after introduction of C3. Continued refinements are needed to further decrease radiation utilization and achieve the goal of zero fluoroscopy.

Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

“…Consistent with the stochastic mechanism of the radiation related injury, previous observational studies reported increased malignancy rates for both patients undergoing electrophysiological procedures and EP lab staff, with a higher biological harm in the pediatric population . For that reason, emerging zero‐fluoroscopy EP procedures (including AVNRT ablation) using 3‐D EAMs have been increasingly introduced in the EP labs . Nonetheless, the accuracy of the geometries generated by 3‐D EAM systems depends on physical and technical parameters, such as the stability of the reference catheter, intracardiac or thoracic impedance, electromagnetic interference in the EP laboratory, etc.…”

“…EAMs are also associated with higher costs and procedure times as compared to fluoroscopy guidance, though some data have been published indicating a financial noninferiority of the utility of 3‐D‐EAM versus conventional fluoroscopy guidance when considering the high treatment costs of malignant complications of the fluoroscopy exposure . Furthermore, some 3‐D EAM systems require dedicated catheters for mapping and generation of endovascular and endocardial shells (other than the cryo‐ablation catheter), which makes the procedure more expensive .…”

“…A zero‐fluoroscopy EPS using three‐dimensional (3‐D) electroanatomic mapping systems (3‐D EAM) is achievable for treatment of most arrhythmias, including AVNRT, but these navigation tools are related to higher costs and procedure times as compared to fluoroscopy guidance …”

Fluoroscopy-free Atrial Transseptal Puncture

“…4,5,12 No groups have reported EAM-only ZFTSP access, but Clark et al have demonstrated that EAM-guided TSP access combined with fluoroscopy is feasible. 6 Reddy et al demonstrated that ICE-guided ZFTSP yielded 90% AF-free success rates at 6.1 months; Montgomery et al follow-up results using the same approach are pending at this time. 11,19 …”

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

“…Obvious group of patients who benefit most from low or ideally ZERO fluoroscopy procedures are children . A larger number of centers have reported their experiences and the use of 3D mapping tools seems to allow a reproducible approach that does not increase the risk of complications (eg, for AV nodal conduction block in AVNRT ablation) . Remote magnetic navigation in young patients seems also result in lesser radiation exposure, a result that has been reported already as one the initial observations using the system in SVT ablation …”