Direct left atrial ICE imaging guided ablation for atrial fibrillation without employing contrast medium

Matsubara, Takumi; Fujiu, Katsuhito; Asada, Kenichi; Kojima, Tadao; Makimoto, Hisaki; Yamagata, Kenichiro; Shimizu, Yu; Hasumi, Eriko; Hatano, Masaru; Akazawa, Hiroshi; Komuro, Issei

doi:10.1016/j.ijcard.2015.11.038

Cited by 3 publications

(13 citation statements)

References 16 publications

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“…At this point, as reported in our previous study 5 , our previous ablation technique, intra-cardiac echogram (ICE) guided mapping combined with CARTOSOUND/CARTO3 (Biosense Webster, Irvine, CA) system, had already resolved preprocedural CT/MRI associated problems. Our previous procedure does not need prior CT images or MRI images 5 . Moreover, our previous technique also can obtain real-time anatomical information during the procedure.…”

supporting

confidence: 64%

“…It is likely that simple techniques will allow ablation operators to learn fluoroless catheter ablation more easily. We previously reported CARTOSOUND/CARTO3 method 5 . The previous study compared the CARTO-SOUND/CARTO3 method to the conventional procedure performed with CARTO Merge system.…”

Section: Discussionmentioning

confidence: 99%

“…Catheter ablations for 76 consecutive cases were performed by one trained operator. The first 18 cases were scheduled to undergo fluoro-group, our conventional method with fluoroscopy and CARTOSOUND system without prior CT/MRI images 5 . The remaining 58 cases were switched to fluoroless catheter ablation group without prior CT/MRI images, radiation exposure or contrast medium.…”

Section: Methodsmentioning

confidence: 99%

“…All geometrics were generated by the images obtained with ICE. The geometry of each chamber of the heart was reconstructed by collecting the 2D ICE images of inner contours as previously reported 5,8 . For pulmonary vein isolation (PVI) or ablation of the left sided accessary pathway, ICE was introduced into the left atrium after Brockenbrough method was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Although our previous technique eliminated the need for contrast media and reduced radiation time. However an average of 16 min of radiation exposure to check the position of guide wire or catheter manipulation during the procedure is still required 5 . The exposure of medical staff to radiation remains a risk 9 .…”

mentioning

confidence: 99%

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Fluoroless and contrast-free catheter ablation without a lead apron in routine clinical practice

Matsubara

Fujiu

Shimizu

et al. 2020

Sci Rep

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The technique of catheter ablation has been improved within the past few decades, especially by three-dimensional (3D) mapping system. 3D mapping system has reduced radiation exposure but ablation procedures still require fluoroscopy. Our previous study showed the safety and efficacy of catheter ablation based on intracardiac echogram combined with CARTOSOUND/CARTO3 system, however fluoroscopy use for an average of 16 min is required for this procedure. The present study was aimed to reduce radiation exposure to zero and establish a radiation free catheter ablation method with the goal of utilizing it in routine clinical practice. We conducted single center, retrospective study during 2019 April to 2020 February. Consecutive 76 patients were enrolled. In the first 18 cases, the previously reported procedure (CARTOSOUND/CARTO3 method) was used. The remaining 58 cases were transitioned to fluoroless catheter ablation. The procedure time, success rates and complication rates were analyzed. Not only AF patients but atrial flutter (AFL), paroxysmal supraventricular tachycardia (PSVT) and ventricular arrhythmia patients were included. Catheter positioning, catheter visualization and collecting the geometry of each camber of the heart were conducted by using contact force and ICE based geometry on CARTO system without either prior computed tomography (CT) or magnetic resonance image (MRI). In fluoroless group, all catheter ablations were successfully performed without lead aprons. No complications occurred in either group. There were no significant differences in procedure time in any type of procedure (Total procedure time Fluoro-group; 149 ± 51 min vs. Fluoroless-group; 162 ± 43 min, N.S.), (PSVT 170 ± 53 min vs. 162 ± 29 min, N.S.), (AFL 110 ± 70 min vs. 123 ± 43 min, N.S.), (AF 162 ± 43 min vs. 163 ± 32 min, N.S.). The total radiation time was reduced to zero in fluoroless group. Catheter ablation with ICE and 3D mapping system guide without fluoroscopy could be safely performed with a high success rate, without any prior CT/MRI 3D images. Radiation was reduced completely for patients and staff, negating the need for protective wear for operators.

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supporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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