open access

Vol 26, No 3 (2019)
Original articles — Interventional cardiology
Published online: 2018-03-26
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Feasibility of zero or near zero fluoroscopy during catheter ablation procedures

Laurent M. Haegeli, Linda Stutz, Mohammed Mohsen, Thomas Wolber, Corinna Brunckhorst, Chol-Jun On, Firat Duru
DOI: 10.5603/CJ.a2018.0029
·
Pubmed: 29611170
·
Cardiol J 2019;26(3):226-232.

open access

Vol 26, No 3 (2019)
Original articles — Interventional cardiology
Published online: 2018-03-26

Abstract

Background: Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a “real world” experience of a single tertiary care center. 

Methods: This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE).

Results: Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy.

Conclusions: This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a “real world” experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.

Abstract

Background: Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a “real world” experience of a single tertiary care center. 

Methods: This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE).

Results: Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy.

Conclusions: This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a “real world” experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.

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Keywords

catheter ablation; fluoroscopy; atrial fibrillation; arrhythmia; three-dimensional electroanatomical mapping

About this article
Title

Feasibility of zero or near zero fluoroscopy during catheter ablation procedures

Journal

Cardiology Journal

Issue

Vol 26, No 3 (2019)

Pages

226-232

Published online

2018-03-26

DOI

10.5603/CJ.a2018.0029

Pubmed

29611170

Bibliographic record

Cardiol J 2019;26(3):226-232.

Keywords

catheter ablation
fluoroscopy
atrial fibrillation
arrhythmia
three-dimensional electroanatomical mapping

Authors

Laurent M. Haegeli
Linda Stutz
Mohammed Mohsen
Thomas Wolber
Corinna Brunckhorst
Chol-Jun On
Firat Duru

References (22)
  1. Lickfett L, Mahesh M, Vasamreddy C, et al. Radiation exposure during catheter ablation of atrial fibrillation. Circulation. 2004; 110(19): 3003–3010.
  2. Rosenthal LS, Beck TJ, Williams J, et al. Acute radiation dermatitis following radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia. Pacing Clin Electrophysiol. 1997; 20(7): 1834–1839.
  3. Ector J, Dragusin O, Adriaenssens B, et al. Obesity is a major determinant of radiation dose in patients undergoing pulmonary vein isolation for atrial fibrillation. J Am Coll Cardiol. 2007; 50(3): 234–242.
  4. Kidouchi T, Suzuki S, Furui S, et al. Entrance skin dose during radiofrequency catheter ablation for tachyarrhythmia: a multicenter study. Pacing Clin Electrophysiol. 2011; 34(5): 563–570.
  5. Calkins H, Niklason L, Sousa J, et al. Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections. Circulation. 1991; 84(6): 2376–2382.
  6. Perisinakis K, Damilakis J, Theocharopoulos N, et al. Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures. Circulation. 2001; 104(1): 58–62.
  7. Scaglione M, Biasco L, Caponi D, et al. Visualization of multiple catheters with electroanatomical mapping reduces X-ray exposure during atrial fibrillation ablation. Europace. 2011; 13(7): 955–962.
  8. Stabile G, Scaglione M, del Greco M, et al. Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system: a multicentre experience. Europace. 2012; 14(1): 60–65.
  9. Huo Y, Christoph M, Forkmann M, et al. Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study. Heart Rhythm. 2015; 12(9): 1945–1955.
  10. Steven D, Servatius H, Rostock T, et al. Reduced fluoroscopy during atrial fibrillation ablation: benefits of robotic guided navigation. J Cardiovasc Electrophysiol. 2010; 21(1): 6–12.
  11. Raju H, Whitaker J, Taylor C, et al. Electroanatomic mapping and transoesophageal echocardiography for near zero fluoroscopy during complex left atrial ablation. Heart Lung Circ. 2016; 25(7): 652–660.
  12. Khaykin Y, Oosthuizen R, Zarnett L, et al. CARTO-guided vs. NavX-guided pulmonary vein antrum isolation and pulmonary vein antrum isolation performed without 3-D mapping: effect of the 3-D mapping system on procedure duration and fluoroscopy time. J Interv Card Electrophysiol. 2011; 30(3): 233–240.
  13. Kozluk E, Rodkiewicz D, Piątkowska A, et al. Safety and efficacy of cryoablation without the use of fluoroscopy. Cardiol J. 2018; 25(3): 327–332.
  14. Limacher MC, Douglas PS, Germano G, et al. ACC expert consensus document. Radiation safety in the practice of cardiology. American College of Cardiology. J Am Coll Cardiol. 1998; 31(4): 892–913.
  15. Haegeli LM, Calkins H. Catheter ablation of atrial fibrillation: an update. Eur Heart J. 2014; 35(36): 2454–2459.
  16. Lee G, Hunter RJ, Lovell MJ, et al. Use of a contact force-sensing ablation catheter with advanced catheter location significantly reduces fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation. Europace. 2016; 18(2): 211–218.
  17. Kühne M, Knecht S, Mühl A, et al. Fluoroscopy-Free pulmonary vein isolation in patients with atrial fibrillation and a patent foramen ovale using solely an electroanatomic mapping system. PLoS One. 2016; 11(1): e0148059.
  18. Bulava A, Hanis J, Eisenberger M. Catheter ablation of atrial fibrillation using zero-fluoroscopy technique: a randomized trial. Pacing Clin Electrophysiol. 2015; 38(7): 797–806.
  19. Reddy VY, Morales G, Ahmed H, et al. Catheter ablation of atrial fibrillation without the use of fluoroscopy. Heart Rhythm. 2010; 7(11): 1644–1653.
  20. Ferguson JD, Helms A, Mangrum JM, et al. Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping. Circ Arrhythm Electrophysiol. 2009; 2(6): 611–619.
  21. Kerst G, Weig HJ, Weretka S, et al. Contact force-controlled zero-fluoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates. Heart Rhythm. 2012; 9(5): 709–714.
  22. Hindricks G, Willems S, Kautzner J, et al. EuroFlutter Investigators. Effect of electroanatomically guided versus conventional catheter ablation of typical atrial flutter on the fluoroscopy time and resource use: a prospective randomized multicenter study. J Cardiovasc Electrophysiol. 2009; 20(7): 734–740.

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