Feasibility of zero or near zero fluoroscopy during catheter ablation procedures

Haegeli, Laurent; Stutz, Linda; Mohsen, Mohammed; Wölber, Thomas; Brunckhorst, Corinna; On, Chol-Jun; Duru, Fırat

doi:10.5603/cj.a2018.0029

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…As expected, there was a significant reduction in both fluoroscopy duration and DAP using an LF approach, however, we also found that overall procedure time was also lower in the LF arm than the CF arm, which suggests that reliance on fluoroscopic imaging during PVI for confirmation of catheter position and sheath manipulation may not only be unnecessary, but also less efficient. Of the 15 studies included in this meta‐analysis, two studies were able to safely accomplish acute PVI in the LF arm without the use of any procedural fluoroscopy, 10,14 and five other studies were able to accomplish PVI in the LF arm with near‐zero fluoroscopy levels 7,8,15,19,20 . In one study, acute isolation was achieved successfully by ICE‐guidance in the LF arm without 3D mapping.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, current practice guidelines recommend minimizing fluoroscopy usage during AF ablation procedures to as low as reasonably achievable in the EP laboratory to limit radiation dose exposure 1,6 . Recently, numerous observational and randomized studies have explored the feasibility and safety of low and zero fluoroscopic radiofrequency (RF) approaches for PVI in comparison to conventional approaches, although all are single‐center studies and the majority have been observational 7‐21 . To better understand the generalizability of low fluoroscopy (LF) approaches for PVI for AF in clinical practice we conducted a meta‐analysis to derive comprehensive estimates of clinical efficacy, safety and procedural parameters between studies comparing low/zero fluoroscopy to conventional fluoroscopy (CF) approaches for PVI.…”

Section: Introductionmentioning

confidence: 99%

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Meta‐analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low‐ and zero‐fluoroscopy approaches

Huang

Abid

Ravi

et al. 2020

Cardiovasc electrophysiol

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Introduction: Radiation exposure during catheter ablation procedures is a significant hazard for both patients and operators. Atrial fibrillation (AF) ablation procedures have been historically associated with higher fluoroscopy usage than other electrophysiology procedures. Recent efforts have been made to reduce dependence on fluoroscopy during pulmonary vein isolation (PVI) ablation procedures using alternative techniques. Methods: We performed a meta-analysis of studies comparing zero or low fluoroscopy (LF) vs conventional fluoroscopy (CF) approaches for AF ablation. Outcomes of interest included acute and 12-month procedural efficacy, safety, procedure duration, fluoroscopy time, and dose area product. Aggregated data were analyzed with random-effects models, using a Bayesian hierarchical approach. Results: A total of 2228 participants (LF, n = 1190 vs CF, n = 1038) from 15 studies were included in the meta-analysis. Risk of AF recurrence in 12 months (odds ratio [OR], 95% confidence interval [95% CI] = 1.343 [0.771-2.340]; P = .297), redoablation procedures (OR [95% CI] = 0.521 [0.198-1.323]; P = .186), and procedural complications (OR [95% CI] = 0.99 [0.485-2.204]; P = .979) were similar between LF-and CF-ablation groups. In comparison to CF ablation, LF ablation led to shorter procedure duration (weighted mean differences [WMDs] [95% CI] = −14.6 minutes [−22.5 to −6.8]; P < .001), fluoroscopy time (WMD [95% CI] = −8.8 minutes [−11.9 to −5.9]; P < .001), and dose area product (WMD [95% CI] = −1946 mGy/cm 2 [−2685 to 1207]; P < .001). Conclusion: LF approaches have similar clinical efficacy and safety as CF approaches for PVI. LF approaches are associated with shorter procedure time, fluoroscopy usage, and dose area product during PVI. K E Y W O R D S atrial fibrillation, catheter ablation, fluoroscopy, pulmonary vein isolation

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low‐ and zero‐fluoroscopy approaches

Huang

Abid

Ravi

et al. 2020

Cardiovasc electrophysiol

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“…Small case series evaluating fluoroless approaches for the ablation of paroxysmal AF have also been reported. 17,[49][50][51][52] In 245 patients with paroxysmal AF, Lyan et al 50 Different from other patient series, O'Brien et al 53 reported their experience with a fluoroless approach using three-dimensional EAM and TEE rather than ICE in a total of 55 AF patients. The total procedural time was similar to that in the fluoroscopic approach group used as a control population and was consistent with previous series performed using ICE instead of TEE.…”

Section: State Of Fluoroless Procedures For Atrial Fibrillationmentioning

confidence: 99%

State of Fluoroless Procedures in Cardiac Electrophysiology Practice

Canpolat

Faggioni

Rocca

et al. 2020

J Innov Cardiac Rhythm Manage

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In the past decade, the use of interventional electrophysiological (EP) procedures for the diagnosis and treatment of cardiac arrhythmias has exponentially increased. These procedures usually require fluoroscopy to guide the advancement and frequent repositioning of intracardiac catheters, resulting in both the patient and the operator being subjected to a considerable degree of radiation exposure. Although shielding options such as lead gowns, glasses, and pull-down shields are useful for protecting the operator, they do not lessen the patient's level of exposure. Furthermore, the prolonged use of lead gowns can exponentiate the onset of orthopedic problems among operators. Recent advancements in three-dimensional cardiac mapping systems and the use of radiation-free imaging technologies such as magnetic resonance imaging and intracardiac ultrasound allow operators to perform EP procedures with minimal or even no fluoroscopy. In this review, we sought to describe the state of fluoroless procedures in EP practice.

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“…to zero under increasing experience of 3D mappings systems and intracardiac electrocardiography. 33,34…”

Section: Advances In Atrial Fibrillation Ablation Devicesmentioning

confidence: 99%

The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications

Keçe

Zeppenfeld

Trines

2018

Arrhythmia &Amp; Electrophysiology Review

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The number of patients with atrial fibrillation currently referred for catheter ablation is increasing. However, the number of trained operators and the capacity of many electrophysiology labs are limited. Accordingly, a steeper learning curve and technical advances for efficient and safe ablation are desirable. During the last decades several catheter-based ablation devices have been developed and adapted to improve not only lesion durability, but also safety profiles, to shorten procedure time and to reduce radiation exposure. The goal of this review is to summarise the reported incidence of complications, considering device-related specific aspects for point-bypoint, multi-electrode and balloon-based devices for pulmonary vein isolation. Recent technical and procedural developments aimed at reducing procedural risks and complications rates will be reviewed. In addition, the impact of technical advances on procedural outcome, procedural length and radiation exposure will be discussed.

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Feasibility of zero or near zero fluoroscopy during catheter ablation procedures

Abstract: Background: Awareness of risks associated with radiation exposure to patients and medical

Cited by 24 publications

References 19 publications

Meta‐analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low‐ and zero‐fluoroscopy approaches

Meta‐analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low‐ and zero‐fluoroscopy approaches

State of Fluoroless Procedures in Cardiac Electrophysiology Practice

The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications

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