Ablação Por Cateter Sem Uso de Fluoroscopia Para Tratamento de Fibrilação Atrial e Arritmias Atriais: Eficácia e Segurança

Abstract

Background: The use of ionizing radiation in medical procedures is associated with significant health risks for patients and the health care team. Objectives: Evaluate the safety and acute efficacy of ablation for atrial fibrillation (AF) and supraventricular arrhythmias (SVTs) using an exclusively non-fluoroscopic approach guided by intracardiac echo (ICE) and 3D-mapping. Methods: 95 pts (mean age 60 ± 18 years, 61% male) scheduled for AF Ablation (69 pts, 45 paroxysmal AF and 24 persistent AF) or non-AF SVT (26 pts-14 AV node reentry, 6 WPW, 5 right atrial (RA) flutters, 1 atrial tachycardia) underwent zero fluoro procedures. Nine patients (9.5%) had permanent pacemakers or defibrillator resynchronization (CRT-D) devices. Both CARTO (65%) and NAVx (35%) mapping systems were used, as well as Acunav and ViewFlex ICE catheters. Results: Pulmonary vein isolation (PVI), as well as all other targets that needed ablation in both atria were reached and adequately visualized. No pericardial effusions, thrombotic complications or other difficulties were seen in these series. Difficult transseptal puncture (19 patients-20%) was managed without fluoroscopy in all cases. No backup fluoroscopy was used, and no lead apparel was needed. Pacemaker interrogations after the procedure did not show any lead damage, dislocation, or threshold changes. Conclusions: A radiation-free (fluoroless) catheter ablation strategy for AF and other atrial arrhythmias is acutely safe and effective when guided by adequate ICE and 3D-mapping utilization. Multiple different bi-atrial sites were reached and adequately ablated without the need for backup fluoroscopy. No complications were seen.

Percutaneous Treatment to Inferior Vena Cava Perforation by Intracardiac Echocardiography Catheter after an Unsuccessful Conservative Approach

“…Iatrogenic injury to the vena cava is a rare but often life-threatening complication [4][5][6][7] . Repair often requires highly invasive surgery at the cost of high morbidity and mortality for the patient 6,8,9 .…”

O Ecocardiograma Intracardíaco Deve Ser Utilizado em Todo Paciente Submetido a Ablação de FA?

“…Além dos benefícios da redução da exposição ao RX o método “zero fluoro” permite reduzir o risco de problemas ortopédicos pela não necessidade dos aventais de chumbo. 8 , 9 Além destas, uma aplicação validada recentemente é a utilização do EIC para a investigação da presença de trombos, principalmente no apêndice atrial esquerdo, antes da realização de ablação de FA, prescindindo do eco tranesofágico. A técnica foi validada recentemente com o posicionamento do cateter do EIC na artéria pulmonar com demonstração de equivalência quando comparada com o eco transesofágico.…”

“…In addition to the benefits of reducing exposure to X-rays, the “zero fluoro” method allows for reducing the risk of orthopedic problems by not requiring lead aprons. 8 , 9 In addition to these, a recently validated application is the use of ICE to investigate the presence of thrombi, mainly in the left atrial appendage, before performing AF ablation, dispensing with transesophageal echo. The technique was recently validated with the positioning of the ICE catheter in the pulmonary artery, demonstrating equivalence when compared with the transesophageal echo.…”