Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

Abstract

Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.

The Field of Cardiac Electrophysiology

“…Advancements to utilize other imaging in substitution of fluoroscopy could potentially be the future of the EP lab. Imaging such as intracardiac echocardiography, cardiac MRI guidance, and 3D electromapping systems have all been proposed [45]. Using these styles of imaging could produce the same result with a much less radiation exposure risk for not only the patient, but also the physician and their team.…”

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

“…26 It is also reported that the heavy shielding equipment might be asso- guidance, and 3D electroanatomic mapping system. 30 Electroanatomic mapping systems rely on the tip space of specialized catheters to generate 3D anatomic reconstructions of interest, which is of great value in guiding needle injections to endocardial sites, identifying a focal arrhythmia origin and guiding ablation procedures. 31 However, there are many factors that may cause suboptimal image fusion, for example, images are not obtained in the same phase of the cardiac cycle or the mapping catheter displaces or tents of the chamber wall.…”

“…Various alternative imaging approaches allowing radiation exposure reduction have been developed such as ICE, cardiac MRI guidance, and 3D electroanatomic mapping system 30 . Electroanatomic mapping systems rely on the tip space of specialized catheters to generate 3D anatomic reconstructions of interest, which is of great value in guiding needle injections to endocardial sites, identifying a focal arrhythmia origin and guiding ablation procedures 31 .…”

Safety and efficacy of zero-fluoroscopy catheter ablation for paroxysmal supraventricular tachycardia in Chinese children

“…Children weighing < 15 kg or aged younger than 5 years have been shown to be at increased risk of complications during RFA, and catheter ablation should be limited to patients with clear indications (4). With the developments in technology, several new techniques, including ICE, MRI-guided cardiac ablation, and three-dimensional mapping, have been used to reduce exposure to radiation in the clinical setting (25,26). Three of these three-dimensional mapping systems are now in widespread clinical use, namely, the CARTO 3 system, the EnSite NavX system (Abbott/St.…”