Zero-fluoroscopy Radiofrequency Redo Ablation of Atrial Tachycardia Following Pulmonary Vein Isolation: A Tale of Two Systems

Percell, Robert L; Sharpe, Erin; Lassen, Teresa M; Maas, Steffani R; Heiss, Lori; Hansen, Dale

doi:10.19102/icrm.2018.091101

Cited by 3 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study is the first, where the zero-fluoroscopic approach was described in consecutive patients scheduled for AF ablation, including repeat ablation procedures. Former reports were mainly focusing on first PVI procedures and apart from case reports, the feasibility of the fluoroscopy free approach in redo AF procedures has not been extensively described yet [26]. According to our first limited experience, repeat AF ablation procedures can also be successfully performed used this novel technique.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures

Treuer

Riba

Németh

et al. 2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Objective Pulmonary vein isolation (PVI) is the cornerstone of the interventional treatment of atrial fibrillation (AF). Traditionally, during these procedures the catheters are guided by fluoroscopy, which poses a risk to the patient and staff by ionizing radiation. Our aim was to describe our experience in the implementation of an intracardiac echocardiography (ICE) guided zero fluoroscopic (ZF) ablation approach to our routine clinical practice. Methods We developed a simplified ICE guided technique to perform ablation procedures for AF, with the aid of a 3D electroanatomical mapping system. The workflow was implemented in two phases: (1) the Introductory phase, where the first 16 ZF PVIs were compared with 16 cases performed with fluoroscopy and (2) the Extension phase, where 71 consecutive patients (including repeat procedures) with ZF approach were included. Standard PVI (and redoPVI) procedures were performed, data on feasibility of the ZF approach, complications, acute and 1-year success rates were collected. Results In the Introductory phase, 94% of the procedures could be performed with complete ZF with a median procedure time of 77.5 (73.5–83) minutes. In one case fluoroscopy was used to guide the ICE catheter to the atrium. There was no difference in the complication, acute and 1-year success rates, compared with fluoroscopy guided procedures. In the Extension phase, 97% of the procedures could be completed with complete ZF. In one case fluoroscopy was used to guide the transseptal puncture and in another to position the ICE catheter. Acute success of PVI was achieved in all cases, 64.4% patients were arrhythmia free at 1-year. Acute major complications were observed in 4 cases, all of these occurred in the redo PVI group and consisted of 2 tamponades, 1 transient ischemic attack and 1 pseudoaneurysm at the puncture site. The procedures were carried out by all members of the electrophysiology unit in the Extension phase, including less experienced operators and electrophysiology fellows (3 physicians) under the supervision of the senior electrophysiologist. Consequently, procedure times became longer [90 (75–105) vs 77.5 (73.5–85) min, p = 0.014]. Conclusions According to our results, a ZF workflow of AF ablations can be successfully implemented into the routine practice of an electrophysiology laboratory, without compromising safety and effectivity.

show abstract

Section: Discussionmentioning

confidence: 99%

Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures

Treuer

Riba

Németh

et al. 2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Regular scheduled electrocardiographic follow-up for efficacy was conducted at two weeks, three months, six months, one year, 18 A full description of the SANS FLUORO has been presented elsewhere. 8,[33][34][35] Briefly, after sheaths were placed, three-dimensional electroanatomic maps of the inferior vena cava, right atrium (RA), right ventricle (RV), and superior vena cava (SVC) as well as the chamber of interest if the ablation was left-sided [eg, pulmonary vein (PV) isolation (PVI), left VT, or left ventricular outflow tract PVC] were generated. Only left-sided lesions requiring transseptal crossings were performed, with ICE conducted by an additional technician (Figure 2).…”

Section: Methodsmentioning

confidence: 99%

The Grand SANS FLUORO (SAy No Series to FLUOROsopy) Study: Examining Fluoroscopy Use in More than 1,000 Ablation Procedures

Percell¹,

Pike²,

Olmsted³

et al. 2020

J Innov Cardiac Rhythm Manage.

Self Cite

View full text Add to dashboard Cite

The majority of electrophysiologists routinely use fluoroscopy (FLUORO) during ablation procedures for common arrhythmias despite the known complications of radiation exposure and protective lead use. This study assessed the safety of catheter ablation (CA) with FLUORO versus without FLUORO (SANS FLUORO) in patients with the following common arrhythmias: atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, and ventricular tachycardia. A total of 1,258 CA procedures were performed in 816 consecutive patients over a 53-month period (SANS FLUORO CA: 609 patients; FLUORO CA: 209 patients). The secondary outcome was the efficacy of AF ablation in FLUORO versus SANS FLUORO patients. Ultimately, there was no statistically significant difference found concerning the safety of CA in the SANS FLUORO and FLUORO groups in terms of procedure time, vascular complications, tamponade, stroke, or death. FLUORO patients had markedly increased FLUORO time, increased radiation exposure, and increased dose-area product (all p < 0.0001). AF development after SANS FLUORO CA of AF was not different from that after FLUORO CA regardless of the pulmonary vein isolation (PVI) modality used (cryoablation versus radiofrequency) at 24 months (p = 0.21). Additionally, women fared just as well as men after CA ablation for AF. At 36 months, 58% of SANS FLUORO AF device patients were free from AF. As such, SANS FLUORO CA of common arrhythmias appears to be as safe as FLUORO CA but with a markedly reduced level of radiation exposure. Also, SANS FLUORO CA remains as effective as FLUORO CA in the prevention of AF for up to 24 months.

show abstract

“…22 This concept applies to both patients and medical personnel. For Percell et al, 1 with respect to the case presented, the ALARA principle implies the use of no fluoroscopy, even in a complex ablation case requiring a redo procedure. One cannot discern if there is any superiority of one three-dimensional mapping system over the other.…”

Section: R N Doshimentioning

confidence: 99%

“…In this month's issue of The Journal of Innovations in Cardiac Rhythm Management, Percell et al 1 report a case of atrial tachycardia after pulmonary vein isolation for atrial fibrillation (AF), in which ablation was performed twice, with both instances occurring without the use of fluoroscopy. Two different mapping systems were used for the two procedures.…”

mentioning

confidence: 99%

Atrial Fibrillation Ablation Without Fluoroscopy: Because We Can

Doshi

2018

J Innov Cardiac Rhythm Manage.

View full text Add to dashboard Cite

Zero-fluoroscopy Radiofrequency Redo Ablation of Atrial Tachycardia Following Pulmonary Vein Isolation: A Tale of Two Systems

Cited by 3 publications

References 16 publications

Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures

Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures

The Grand SANS FLUORO (SAy No Series to FLUOROsopy) Study: Examining Fluoroscopy Use in More than 1,000 Ablation Procedures

Atrial Fibrillation Ablation Without Fluoroscopy: Because We Can

Contact Info

Product

Resources

About