Exclusion of Fluoroscopy Use in Catheter Ablation Procedures: Six Years of Experience at a Single Center

Fernández-Gómez, Juan Manuel; Moriña‐Vázquez, Pablo; Morales, Elena Del Rio; Venegas‐Gamero, José; Barba-Pichardo, Rafael; Carranza, M. Herrera

doi:10.1111/jce.12385

Cited by 57 publications

(33 citation statements)

References 20 publications

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“…The feasibility of eliminating x-ray use altogether by using a 3D mapping system was demonstrated in a relatively small pediatric study showing a 95% reduction in fluoroscopy time with 24 of 30 patients requiring no fluoroscopy whatsoever 29 . The "near-zero" radiation objective has been achieved in subsequent studies using the NavX system for all steps of the procedure instead of fluoroscopy, other than in a variety of arrhythmias, also for atrioventricular nodal reentry tachycardia 30 , 31 .…”

Section: Typical Atrial Fluttermentioning

confidence: 99%

“…In this series, ablation success rate was 95% and no complications occurred. A more recent study reported on the systematic use of a a nonfluoroscopic approach in a larger cohort of 328 patients 35 . This group consisted of 35 patients with AVRT whereas patients with left sided accessory pathway or those who needed a transeptal puncture were excluded from the study.…”

Section: Atrioventricular Re-entrant Tachycardia Reciprocating Atriomentioning

confidence: 99%

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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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Section: Typical Atrial Fluttermentioning

confidence: 99%

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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“…While mapping systems are extremely useful in the treatment of these complex conditions, in the last 15 years some studies have demonstrated that they can also be applied to CA of simple arrhythmias [4,6,10,15,16]. The use of mapping systems in these cases does not compromise the treatment or make it less effective in comparison with traditional CA.…”

Section: Discussionmentioning

confidence: 98%

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

et al. 2016

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Standard imaging during electrophysiological procedures (EPs) uses fluoroscopy. The aim of this study was to evaluate the feasibility, efficacy, safety and effect of an extended use of non-fluoroscopic mapping systems (NMSs) for imaging during paediatric EPs in an adult EP laboratory focusing on the amount of X-ray exposure. This study is a retrospective analysis that includes consecutive young patients (83 pts, aged between 8 and 18) who underwent EPs from March 2005 to February 2015. We compare the fluoroscopy data of two groups of pts: Group I, pts who underwent EPs from 2005 to 2008 using only fluoroscopy and Group II, pts who underwent EPs from 2008 to 2015 performed also using NMSs. The use of an NMS resulted in reduced fluoroscopy time in Group II {median value 0.1 min (95 % CI [0.00-1.07])} compared to Group I {median value 3.55 min (95 % CI [1.93-7.83]) (MW test, P < 0.05)}. There was a complementary reduction in the total X-ray exposure from 2.53 Gy cm(2) (95 % CI [1.51-4.66]) in Group I to 0.05 Gy cm(2) in Group II (95 % CI [0.00-1.22]) (MW test, P < 0.05). Regarding ablation procedures, the median effective dose decreased from 3.04 mSv (95 % CI [1.22-6.89]) to 0.25 mSv (95 % CI [0.00-0.60]) (MW test, P < 0.05). The use of an NMS dramatically reduces fluoroscopy time and total X-ray exposure during EPs in children and teenagers in an adult EP laboratory. In our experience, this reduction is mainly related to the systematic day-to-day use of NMSs.

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“…4–7,9–13,15–19 Kühne et al advocate using transesophageal echocardiography (TEE) prior to TSP access, 10 whereas several groups describe intra-procedural TEE-guided TSP access with a high degree (97–100%) of AF-free event rates during respective follow-up periods. 13,16,17 Other groups have described TEE-guided TSP in combination with fluoroscopy to minimise radiation exposure, however reported outcomes from this approach demonstrated comparatively reduced AF-free success rates (75–85%).…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopy-free Atrial Transseptal Puncture

McCauley¹,

Patel²,

Greenberg³

et al. 2016

European Journal of Arrhythmia &Amp; Electrophysiology

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Introduction Fluoroscopy is traditionally used in atrial transseptal puncture (TSP); however fluoroscopy exposes patient and physician to excess radiation. Here, we describe a feasibility study of a zero-fluoroscopy transseptal puncture (ZFTSP) technique utilising electroanatomical mapping (EAM) and intracardiac echo (ICE) in a small case series of patients undergoing ablation for atrial fibrillation (AF). We then compare this technique to other established ZFTSP techniques for paroxysmal AF ablation. Methods Seven patients received ZFTSP. An Acunav™ ICE catheter (Biosense Webster Inc., California, US) was placed in the right atrium, then an Agilis™ sheath (St. Jude Medical, Saint Paul, Minnesota, US) was established into the inferior vena cava. A ThermoCool® SmartTouch™ catheter (Biosense Webster Inc., California, US) was inserted through the Agilis to map the fossa ovalis. Mapping catheter exchange for dilator and needle allowed for facile ZFTSP. AF outcome, fluoroscopy times, and procedure times were compared with eight age-matched control patients. Results There were no significant differences in age, body mass index (BMI) or AF duration between the two groups and no immediate complications. ZFTSP procedure time was 183.9±33.7 minutes versus 293.13±129.9 minutes for TSP-only controls (p=0.05). Fluoroscopy time was 17.5±14.1 minutes in ZFTSP patients versus 73.4±50.3 minutes in controls (p=0.01). AF recurrence in ZFTSP patients was 14% versus 25% in controls. Conclusion ZFTSP utilising ICE and EAM is safe, effective, and time-efficient. There is a small but significant reduction in radiation exposure to patient and physician by the use of this technique.

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Exclusion of Fluoroscopy Use in Catheter Ablation Procedures: Six Years of Experience at a Single Center

Abstract: RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective.

Cited by 57 publications

References 20 publications

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

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

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

Fluoroscopy-free Atrial Transseptal Puncture

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