Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias

Christoph, Marian; Wunderlich, Carsten; Moebius, Stefanie; Forkmann, Mathias; Sitzy, J; Salmas, Jozef; Mayer, Julia; Huo, Yan; Piorkowski, Christopher; Gaspar, Thomas

doi:10.1093/europace/euu334

Cited by 67 publications

(53 citation statements)

References 13 publications

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“…These systems are proving sufficiently versatile and are permitting to reduce radiation exposure even further than "conventional" 3D mapping 32 , 33 .…”

Section: Typical Atrial Fluttermentioning

confidence: 99%

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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“…These systems are proving sufficiently versatile and are permitting to reduce radiation exposure even further than "conventional" 3D mapping 32 , 33 .…”

Section: Typical Atrial Fluttermentioning

confidence: 99%

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

et al. 2016

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“…No patient underwent left atrial linear ablation with the CartoUnivu system in previous reports. [19,22] Therefore, we conclude that a simple reduction in the fluoroscopy rate should be immediately achievable in most clinical settings.…”

Section: Discussionmentioning

confidence: 84%

“…In this study, the efficacy and safety of AF procedure using a 2-FPS setting was comparable to that of the 4-FPS setting. Considering the higher radiation exposure (7369–8690 cGy cm 2 ) reported in conventional 7.5-FPS settings, [7,19] we believe that utilizing either 2-FPS or 4-FPS modes may substantially decrease radiation exposure without significantly compromising the therapeutic efficacy. Currently, the 2-FPS setting is routinely used at our institution for ablation procedures for AF, as well as in other contexts such as supraventricular tachycardia, atrial flutter, and ventricular tachycardia.…”

Section: Discussionmentioning

confidence: 99%

Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation

Lee

Kim

et al. 2017

Medicine

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“…The described approach combines currently existing tools to create added value to the procedure. Originally, the applied CARTO UNIVU image integration module was developed to overlay catheter acquired maps (“FAM”) onto fluoroscopy . However, it can also be used to integrate segmented DICOM datasets (computed tomography, magnetic resonance imaging) into fluoroscopic imaging as well.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures

Bourier

Vlachos

Lam

et al. 2019

Cardiovasc electrophysiol

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Background We present a new, easily applicable approach for the guidance of cryoballoon (CB) pulmonary vein isolation (PVI) procedures that use the combination of a 3D‐mapping system image integration module and computed tomographic (CT)–derived anatomy. The aim of this retrospective, nonrandomized study was to investigate: (a) an alternative use for an established radiofrequency image integration module for cryo procedures; (b) a guidance technology for cryo PVI based on integrated CT anatomy; and (c) its clinical impact. Methods and results CT left atrium–angiography was performed in 50 consecutive patients before a CB PVI procedure, and a 3D reconstruction of the cardiac anatomy was segmented. A total of 25 patients were treated using conventional fluoroscopy; 25 patients were treated using the 3D image integration technique. In the image integration group, the CARTO3 UNIVU (Biosense Webster) module was used for image integration of 3D anatomy and fluoroscopic imaging. Transseptal puncture and cryo PVI were guided by 3D‐overlay imaging. Procedures were feasible without complications in all patients and cryo PVI procedures were successfully guided using the image integration technique. The intraprocedural time needed to perform image integration was 37 ± 10 seconds. Fluoroscopy time was 31.7 ± 11.7 minutes in the conventional group and 20.1 ± 7.9 minutes in the image integration group (P < .001), procedure time was 116.3 ± 29.0 minutes in the conventional group vs 101.2 ± 20.9 minutes in the 3D group (P = .04). Conclusion 3D‐overlay guidance of CB PVI is feasible, safe, and applicable in real time with minimal effort. It may significantly reduce radiation exposure by introducing 3D information, known from electroanatomic mapping systems, into cryo PVI procedures.

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Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias

Cited by 67 publications

References 13 publications

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

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

Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation

Three‐dimensional image integration guidance for cryoballoon pulmonary vein isolation procedures

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