Impact of a computer assisted navigation system on radiation exposure during pediatric ablation procedures

Abstract

The use of a computer assisted navigation system significantly decreased the diagnostic, ablation, and total fluoroscopy times, as well as the number of energy applications, without affecting procedural success or complication rates. Non-radiologic navigation systems reduce radiation exposure during transcatheter electrophysiologic procedures and thus lower the lifetime radiation cumulative risk, a goal particularly important in children.

Radiofrequency Ablation of Accessory Pathways in Children and Congenital Heart Disease Patients: Impact of a Nonfluoroscopic Navigation System

“…Other authors used different systems including Loca‐Lisa (Medtronic Inc, MN, USA), 5 and Ensite NavX (Endocardial Solutions Inc., St. Paul, MN, USA) 6–10 to ablate a variety of substrates such as left‐and right‐sided APs, AV nodal reentrant tachycardia (AVNRT), and ectopic atrial tachycardia (EAT). Most authors demonstrated significant reduction in fluoroscopy times with unchanged or even increased procedure times except for our previous study, 6 which showed a reduction in both.…”

“…The development of nonfluoroscopic navigation methods has allowed for limited use or even complete exclusion of fluoroscopy. However, the series that have been published so far consist of relatively small groups of patients 4–9 . In addition, it is not known if the beneficial effect of these methods is related to the location and substrate of tachycardia.…”

“…However, the series that have been published so far consist of relatively small groups of patients. [4][5][6][7][8][9] In addition, it is not known if the beneficial effect of these methods is related to the location and substrate of tachycardia. We analyzed retrospectively our database of all ablation procedures performed for accessory pathways (APs) in children and adolescents to assess the impact of the routine use of a nonfluoroscopic method.…”

Magnetic Versus Manual Catheter Navigation for Ablation of Free Wall Accessory Pathways in Children

“…13,14 In our institution, use of a 3-dimensional mapping system to allow for decreased fluoroscopy regardless of navigation technique has become standard care. Regardless of the primary reason, however, reduced fluoroscopy times remain important to consider because any reduction in radiation exposure in young children may have lasting effects.…”

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

“…59 Besides aiding intracardiac navigation, this was extremely helpful when advancing the catheters from the femoral accesses toward the heart, a maneuver that otherwise exposed the "vulnerable" genital area when performed using fluoroscopic guidance (Figure 14-1C). 325 With the evolution of the 3D mapping systems over the last 20 years, especially with the improvement in the accuracy of the catheter position during the entire cardiac cycle with respiratory gating, the display of all (even nonsensored) catheters 22 and fast reconstructions of any given heart chamber has reduced total radiation exposure for nearly all procedures significantly. 79,326,327 Recommendations for 3D mapping of zero-fluoroscopy approch is described in…”