Low-fluoroscopy atrial fibrillation ablation with contact force and ultrasound technologies: a learning curve

Abstract

BackgroundFluoroscopy exposure during catheter ablation is a health hazard to patients and operators. This study presents the results of implementing a low-fluoroscopy workflow using modern contact force (CF) technologies in paroxysmal atrial fibrillation (PAF) ablation.MethodsA fluoroscopy reduction workflow was implemented and subsequent catheter ablations for PAF were evaluated. After vascular access with ultrasound guidance, a THERMOCOOL SMARTTOUCH® Catheter (ST) was advanced into the right atrium. The decapolar catheter was placed without fluoroscopy. A double-transseptal puncture was performed under intracardiac echocardiography guidance. ST and mapping catheters were advanced into the left atrium. A left atrial map was created, and pulmonary vein (PV) isolation was confirmed via entrance and exit block before and after the administration of isoproterenol or adenosine.ResultsForty-three patients underwent PAF ablation with fluoroscopy reduction workflow (mean age: 66±9 years; 70% male), performed by five operators. Acute success rate (PV isolation) was 96.5% of PVs. One case of pericardial effusion, not requiring intervention, was the only acute complication. Mean procedure time was 217±42 minutes. Mean fluoroscopy time was 2.3±3.0 minutes, with 97.7% of patients having < 10 minutes and 86.0% having < 5 minutes. A significant downward trend over time was observed, suggesting a rapid learning curve for fluoroscopy reduction. Freedom from any atrial arrhythmias without reablation was 80.0% after a mean follow-up of 12±3 months.ConclusionLow fluoroscopy time is achievable with CF technologies after a short learning curve, without compromising patient safety or effectiveness.

Safety and efficacy of zero fluoroscopy transseptal puncture with different approaches

“…These observations were consistent across all participating centers, which included both academic and private institutions, with varying techniques utilized, as described, across a large number of patients. In a recent study, learning curve of reduced fluoroscopy use was assessed when it was first adopted in an academic teaching center where in just 43 procedures, median fluoroscopy time per procedure was reduced to 9 s, from 3.8 min without any significant change in total procedure time, suggesting a rapid learning curve …”

Aegrescit medendo: orthopedic disability in electrophysiology - call for fluoroscopy elimination—review and commentary

“…In their analysis, the steepest learning curve occurred over the first 40 cases of PVI, 20 cases for SVT, and 15 cases for PVCs. A similar single-center, retrospective analysis by Zei and colleagues demonstrated the safety and efficacy of a fluoroscopic reduction workflow for PVI [49]. A significant downward trend in the mean fluoroscopic time was observed, suggesting a rapid learning curve.…”

Steerable sheath visualizable under 3D electroanatomical mapping facilitates paroxysmal atrial fibrillation ablation with minimal fluoroscopy

“…To date, several observational and randomized studies have demonstrated that well-constructed workflows accompanied by appropriate operator training can facilitate successful transition to low-to-zero fluoroscopy catheter ablation procedures [ 1 , 11 , 19 – 23 ]. Our results showed that the 3D EAM-visualizable sheath can be incorporated into an existing low/zero fluoroscopy workflow seamlessly, while further reducing the RF ablation time and improving catheter stability.…”