Off the pedal: Fluoroless transseptal puncture in pediatric supraventricular tachycardia ablation

Clark, Bradley C.; Sumihara, Kohei; Berul, Charles I.; Moak, Jeffrey P.

doi:10.1111/pace.13195

Cited by 13 publications

(10 citation statements)

References 13 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Cheng

Liang

et al. 2020

Clinical Cardiology

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Background Right atrial electroanatomical mapping may be combined with SoundStar 3D diagnostic ultrasound catheter (EAM‐ICE) as a zero‐fluoroscopy procedure for radiofrequency catheter ablation (RFCA). We aimed to evaluate the efficiency and safety of zero‐fluoroscopy transseptal puncture guided by EAM‐ICE and fluoroscopy combined with intracardiac echocardiography (F‐ICE) in patients with paroxysmal atrial fibrillation (PAF). Hypothesis Zero‐fluoroscopy transseptal puncture is an effective and safe procedure. Methods This study had a prospective design. A total of 57 patients with PAF were enrolled and assigned to two groups. Twenty‐seven patients were enrolled in the EAM‐ICE group, and 30 patients were enrolled in the F‐ICE group. Results There were no statistically significant differences in baseline patient characteristics between groups. Transseptal puncture was successful in all patients (57/57, 100%). Total procedure time and duration of transseptal puncture were lower in the F‐ICE group (199.4 ± 26.0 minutes vs 150.7 ± 22.1 minutes, P = 0.000; 118.4 ± 19.7 vs 70.5 ± 13.5 minutes, P = 0.000). There was no use of fluoroscopy in the EAM‐ICE group (0 mGy vs 70.5 ± 13.5 mGy); the duration of fluoroscopy in the EAM‐ICE group was negligible (0 minutes vs 5.4 ± 1.9 minutes). No procedural complication occurred in either group. Conclusions EAM‐ICE guided zero‐fluoroscopy transseptal puncture is an effective and safe procedure.

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Section: Discussionmentioning

confidence: 99%

“…Clark et al reported a cohort study in which EAM was used in combination with ICE to perform transseptal puncture. By pulling down the ablation catheter, the authors located the position of the foramen ovale 17 . However, the advantages of EAM were not fully utilized in their study.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Cheng

Liang

et al. 2020

Clinical Cardiology

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“…Furthermore, as the volume of atrial fibrillation procedures rises, concern over patient and staff radiation exposure continues to increase 2, 12, 13. While nonfluoroscopic guidance systems, such as ICE, TEE, and 3D EAM, have been increasingly used in catheter ablation procedures to reduce or completely eliminate fluoroscopy,4, 5, 6, 7, 8, 14 transseptal access is often regarded as the main challenge in completely nonfluoroscopic catheter ablation 15 . This step requires visualization of the drop-down of the device tip from the brachiocephalic vein or SVC to the fossa ovalis, which is traditionally performed under fluoroscopic guidance.…”

Section: Discussionmentioning

confidence: 99%

Long-standing persistent atrial fibrillation ablation without use of fluoroscopy in a patient with cor triatriatum

Shah

Mohanty

Gilligan

et al. 2019

HeartRhythm Case Reports

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“…Pediatric electrophysiology has been at the forefront of zerofluoroscopic techniques over the past decade [39][40][41]. Given the young age of these patients and their relatively long life expectancy compared with adults, providers must carefully weigh the effects of ionizing radiation exposure.…”

Section: Unique Populationsmentioning

confidence: 99%

Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

2021

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Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.

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Off the pedal: Fluoroless transseptal puncture in pediatric supraventricular tachycardia ablation

Abstract: Fluoroless TS procedures utilizing ICE can safely be performed in pediatric patients without adding substantial procedural times compared with those utilizing fluoroscopic guidance.

Cited by 13 publications

References 13 publications

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

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

Long-standing persistent atrial fibrillation ablation without use of fluoroscopy in a patient with cor triatriatum

Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

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