The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia

Mah, Douglas Y.; Miyake, Christina Y.; Sherwin, Elizabeth D.; Walsh, Amy Z.; Anderson, Michael J.; Western, Kara; Abrams, Dominic J.; Alexander, Mark E.; Cecchin, Frank; Walsh, Edward P.; Triedman, John K.

doi:10.1093/europace/eut237

Cited by 64 publications

(72 citation statements)

References 14 publications

(7 reference statements)

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“…Six studies reported zero (0) peri‐procedural complications in one or both arms 10,26–28,30,36 and there was no observable heterogeneity among the 13 studies included in the analysis (I 2 = 0%) 11,22,24,26–28,30–32,34,36–38 . A nonsignificant decrease in complications was demonstrated in ablations with the use of ICE vs no ICE (RR 0.66; 95% CI, 0.42‐1.05, P = .08) (Figure S3C).…”

Section: Resultsmentioning

confidence: 96%

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The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

Goya

Frame

Gache

et al. 2020

Cardiovasc electrophysiol

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Aims The optimal use of intracardiac echocardiography (ICE) may reduce fluoroscopy time and procedural complications during endocardial ablation of cardiac arrhythmias. Due to limited evidence in this area, we conducted the first systematic literature review and meta‐analysis to evaluate outcomes associated with the use of ICE. Methods and Results Studies reporting the use of ICE during ablation procedures vs without ICE were searched using PubMed/MEDLINE. A meta‐analysis was performed on the 19 studies (2186 patients) meeting inclusion criteria, collectively representing a broad range of arrhythmia mechanisms. Use of ICE was associated with significant reductions in fluoroscopy time (Hedges' g −1.06; 95% confidence interval [CI] −1.81 to −0.32; P < .01), fluoroscopy dose (Hedges' g −1.27; 95% CI −1.91 to −0.62; P < .01), and procedure time (Hedges' g −0.35; 95% CI −0.64 to −0.05; P = .02) vs ablation without ICE. A 6.95 minute reduction in fluoroscopy time and a 15.2 minute reduction in procedure time was observed between the ICE vs non‐ICE groups. These efficiency gains were not associated with any decreased effectiveness or safety. Sensitivity analyses limiting studies to an atrial fibrillation (AF) only population yielded similar results to the main analysis. Conclusion The use of ICE in the ablation of cardiac arrhythmias is associated with significantly lower fluoroscopy time, fluoroscopy dose, and shorter procedure time vs ablation without ICE. These efficiency improvements did not compromise the clinical effectiveness or safety of the procedure.

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Section: Resultsmentioning

confidence: 96%

“…Nineteen studies with a total sample size of 2186 patients were included in the main analysis, encompassing patients with any form of atrial or ventricular arrhythmia undergoing catheter ablation (see Table S2 for individual study details) 10,22–38 . The characteristics of the included studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

Goya

Frame

Gache

et al. 2020

Cardiovasc electrophysiol

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“…Unfortunately, in this setting, left sided accessory pathways requiring transeptal puncture were not studied. As discussed subsequently in the section on, atrial fibrillation ablation, intracardiac echography (ICE) may eventually play a role in reducing fluoroscopy exposure during transeptal puncture 38 , but such an approach still needs to be standardized and validated.…”

Section: Atrioventricular Re-entrant Tachycardia Reciprocating Atriomentioning

confidence: 99%

The dream of near-zero X-rays ablation comes true

et al. 2016

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Abstract:While radiation exposure related to natural sources plays a minor role, medicine-related exposure, represents, to date, a major exposure source. Within this exposure interventional electrophysiology is a relevant contributor. Unfortunately no safe dose in radioprotection exists, the negative acute and long term effects of radiological exposure may emerge at any radiation exposure dose. For this reason patients and physicians should be aware of the risk of radiation exposure and the benefits of the imaging/procedure balanced by the required radiation exposure. Given this, performing a near to zero x-rays transcatheter ablation procedure should therefore represent an aim for all electrophysiological lab. Fortunately, the introduction of electroanatomic mapping systems, have provided the possibility to perform simple and complex electrophysiological procedures avoiding, or at least, limiting the use of radiations. The present review summarizes state of the art of feasibility and safety of the near to zero approach for the main electrophysiological procedures, highlighting the potential health benefits.3

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“…The most successful strategy for reducing the risk of ionizing radiation for all parties involved would be to minimize exposure altogether (both time and dose). Ancillary imaging modalities (such as 3DM and ultrasound) that do not utilize ionizing radiation are important and often underused tools that may reduce reliance on radiation‐based imaging modalities . When coupled with other dose reduction strategies (including reduced frame rate, adjusting tube voltage and tube current, and use of collimation) exposure to ionizing radiation can be drastically reduced .…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopy reduction during device implantation by using three‐dimensional navigation. A single‐center experience

Larsen

Saini

Moore

et al. 2019

Cardiovasc electrophysiol

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Background and objectives The use of nonfluoroscopic three‐dimensional electroanatomic mapping (3DM) systems reduces radiation exposure during ablation procedures. In this study, we sought to determine the value of 3DM during routine device implant procedures. Methods Seventy nonselected patients underwent implantation of a single chamber, dual chamber, or biventricular device guided by Ensite (Abbott Laboratories) to limit fluoroscopy use and compared with 70 consecutive patients, who underwent matching procedures with standard fluoroscopy use (FL) in the period immediately preceding the use of 3DM. The venous anatomy, right atrium, and ventricle and coronary sinus were mapped with 0.035 inch J‐wire, quadripolar catheter, and/or angioplasty wire. The leads were advanced under real‐time visualization in Ensite. Results 3DM reduced both fluoroscopy time and dose. Median fluoroscopy time for FL vs 3DM was 5.5 minutes (interquartile range [IQR]: 3.8‐8.1) vs 0.9 minutes (IQR: 0.6‐1.9) (P < .001) for single chamber devices, 6.3 minutes (IQR: 5.1‐7.9) vs 3.3 minutes (IQR: 1.9‐4) (P < .001) for dual‐chamber devices, and 28.6 minutes (IQR: 19.6‐36.2) to 14.7 minutes (IQR: 10.4‐22.3) (P = .009) for biventricular devices, respectively. The median air kerma for FL vs 3DM was 15.4 mGy (IQR: 8.1‐30.2) vs 4 mGy (IQR: 1.8‐8) (P < .001) for single chamber devices, 16 mGy (IQR: 12‐18.5) to 9.4 mGy (IQR: 7.5‐11.3) (P = .001) for dual‐chamber devices, and 324 mGy (IQR: 143‐668.7) to 115 mGy (IQR:77‐204) (P = .014) for biventricular devices, respectively. There were no procedural complications. At 3‐month follow‐up, there was no difference in voltage threshold measurements between the groups. Conclusion The use of 3DM leads to significantly reduced fluoroscopy time and fluoroscopy dose during routine device implantation.

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The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia

Abstract: Use of an integrated EAM/ICE system was no better than EAM alone in limiting radiation, but can be helpful for transseptal punctures. Given the low dose savings, use of ICE may be weighed against its financial cost. Low-fluoroscopy cases are performed in most NFI procedures.

Cited by 64 publications

References 14 publications

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

The dream of near-zero X-rays ablation comes true

Fluoroscopy reduction during device implantation by using three‐dimensional navigation. A single‐center experience

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