A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation

Falasconi, Giulio; Penela, Diego; Soto‐Iglesias, David; Jáuregui, Beatriz; Chauca, Alfredo; Antonio, Rodolfo San; Ordóñez, A; Terés, Cheryl; Carreño, José Miguel; Scherer, Claudia; Viveros, Daniel; Huguet, Marina; Torres, José Manuel; Vergara, Pedro; Maldonado, Giuliana; Panaro, A; Cámara, Óscar; Berruezo, Antonio

doi:10.1007/s10840-021-01086-9

Cited by 17 publications

(9 citation statements)

References 18 publications

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“…Falasconi et al . 6 demonstrated 96.7% of risk reduction in fluoroscopic dose compared with the conventional approach in 111 cases of RFCA for AF based on TEE. Recently, ICE-guided fluoroless or near-zero-fluoroscopic RFCA for AF has been performed in many experienced centres.…”

Section: Discussionmentioning

confidence: 95%

Safety and efficacy of intracardiac echocardiography–guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial

et al. 2023

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Aims The development of intracardiac echocardiography (ICE) has enabled fluoroless atrial fibrillation (AF) ablation using three-dimensional electroanatomical mapping systems. However, fluoroless cryoballoon ablation (CBA) remains challenging, mainly because of the lack of a visual mapping system. Hence, this study aimed to investigate the safety and efficacy of fluoroless CBA for AF under ICE guidance. Methods and results Patients (n = 100) who underwent CBA for paroxysmal AF were randomly assigned to zero-fluoroscopic (Zero-X) and conventional groups. Intracardiac echocardiography was used to guide the transseptal puncture and catheter and balloon manipulation in all enrolled patients. The patients were prospectively followed for 12 months after CBA. The mean age was 60.4 years, and the left atrial (LA) size was 39.4 mm. Pulmonary vein isolation (PVI) was achieved in all patients. In the Zero-X group, fluoroscopy was used in only one patient because of unstable phrenic nerve capture during right-sided PVI. The procedure time and LA indwelling time in the Zero-X group were not statistically different compared with that in the conventional group. Fluoroscopic time (9.0 vs. 0.008 min) and radiation exposure (29.4 vs. 0.02 mGy) were significantly shorter in the Zero-X group than in the conventional group (P < 0.001). The complication rate did not differ between the two groups. During a mean follow-up of 663.3 ± 172.3 days, the recurrence rate was similar (16.0 vs. 18.0%; P = 0.841) between the groups. Multivariate analysis revealed that LA size was the only independent predictor of clinical recurrence. Conclusion Intracardiac echocardiography–guided fluoroless CBA for AF was a feasible strategy without compromising acute and long-term success or complication rates.

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Section: Discussionmentioning

confidence: 95%

Safety and efficacy of intracardiac echocardiography–guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial

et al. 2023

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“…This was due to the LAWT-guided AI titration and to the personalized ablation line aiming to avoid the thickest LA regions whenever possible. The use of a standardized stepwise near zero-fluoroscopy approach with TOE guidance 25 and the use of the pre-procedural imaging integration may explain the low fluoroscopy requirements. As reported by Marrouche et al ., 12 procedure duration is an important issue, especially keeping in mind that a higher rate of complications has been generally observed in ablations requiring longer procedural times, regardless of the strategy used.…”

Section: Discussionmentioning

confidence: 99%

“… 23 , 24 Transseptal puncture was guided by transoesophageal echocardiography (TOE), performed by cardiologists experienced in cardiac imaging. 25 All procedures were performed with single catheter technique, 26 using a contact force-sensing irrigated ablation catheter (Thermocool Smarttouch, Biosense Webster Inc., CA, USA). A fast-anatomical map (FAM) of the entire LA anatomy and the PVs was acquired and then merged with the imported 3D LAWT map within the spatial reference coordinates of the CARTO system.…”

Section: Methodsmentioning

confidence: 99%

Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

et al. 2023

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Aims Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF. Methods and results Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50–67), fluoroscopy time was 43 s (IQR 20–71), and radiofrequency (RF) time was 16.5 min (IQR 14.3–18.4). The median AI tailored to the local LAWT was 387 (IQR 360–410) for the anterior wall and 335 (IQR 300–375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up. Conclusion In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).

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“…Oral anticoagulation was uninterrupted, and periprocedural anticoagulation was performed to achieve an activated clotting time >300 seconds. All procedures were performed with a single venous femoral access and a near-zero fluoroscopy protocol, 10 which is the usual local protocol except for atypical atrial flutters requiring a reference catheter (right atrial quadripolar; St Jude Medical, Inc., St. Paul, MN). Transseptal puncture was guided by TEE.…”

Section: Methodsmentioning

confidence: 99%

Relationship between the posterior atrial wall and the esophagus: Esophageal position during atrial fibrillation ablation

et al. 2022

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A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation

Cited by 17 publications

References 18 publications

Safety and efficacy of intracardiac echocardiography–guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial

Safety and efficacy of intracardiac echocardiography–guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial

Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

Relationship between the posterior atrial wall and the esophagus: Esophageal position during atrial fibrillation ablation

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