“Near-zero” fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX™ mapping system: personal experience and review of the literature

Casella, Michela; Pelargonio, Gemma; Russo, Antonio Dello; Riva, Stefania; Bartoletti, Stefano; Santangeli, Pasquale; Scarà, Antonio; Sanna, Tommaso; Proietti, Riccardo; Biase, Luigi Di; Gallinghouse, G. Joseph; Narducci, Maria Lucia; Sisto, Luigi; Bellocci, Fulvio; Natale, Andrea; Tondo, Claudio

doi:10.1007/s10840-011-9553-5

Cited by 92 publications

(66 citation statements)

References 27 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%

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%

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

et al. 2016

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“…4,11) The beneficial effect of two 3D-electroanatomical mapping systems (CARTO3 ® , Biosense Webster and NAVX TM , St. Jude Medical) in their radiation saving potential has already been demonstrated. 12,13) Even as such they allow for a reduction of fluoroscopy time due to the possibility of moving catheters in a created anatomical map omitting the necessity for some fluoroscopic interventions within a given procedure. But still they are not able to integrate fluoroscopic images into the map.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter

et al. 2016

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SummaryPulmonary vein isolation (PVI) is a cornerstone therapy in patients with atrial fibrillation (AF). With increasing numbers of PVI procedures, demand arises to reduce the cumulative fluoroscopic radiation exposure for both the physician and the patient. New technologies are emerging to address this issue. Here, we report our first experiences with a new fluoroscopy integrating technology in addition to a current 3D-mapping system. The new fluoroscopy integrating system (FIS) with 3D-mapping was used prospectively in 15 patients with AF. Control PVI cases (n = 37) were collected retrospectively as a complete series. Total procedure time (skin to skin), fluoroscopic time, and dose-area-product (DAP) data were analyzed. All PVI procedures were performed by one experienced physician using a commercially available circular multipolar irrigated ablation catheter. All PVI procedures were successfully undertaken without major complications. Baseline characteristics of the two groups showed no significant differences. In the group using the FIS, the fluoroscopic time and DAP were significantly reduced from 571 ± 187 seconds versus 1011 ± 527 seconds (P = 0.0029) and 4342 ± 2073 cGycm 2 versus 6208 ± 3314 cGycm 2 (P = 0.049), respectively. Mean procedure time was not significantly affected and was 114 ± 31 minutes versus 104 ± 24 minutes (P = 0.23) by the FIS.The use of the new FIS with the current 3D-mapping system enables a significant reduction of the total fluoroscopy time and DAP compared to the previous combination of 3D-mapping system plus normal fluoroscopy during PVI utilizing a circular multipolar irrigated ablation catheter. However, the concomitant total procedure time is not affected. Thus, the new system reduces the radiation exposure for both the physicians and patients. (Int Heart J 2016; 57: 299-303)

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“…Although these estimates are difficult to objectively quantify and interpret, any effective method to minimise radiation exposure is likely beneficial for both patients and medical staff. (13,14) Such considerations are important, especially when the advantages of NFS are weighed against its apparent excessive cost. The present study was not without limitations.…”

Section: Discussionmentioning

confidence: 99%

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

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Amora

Sheldon

et al. 2016

smedj

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INTRODUCTIONRadiofrequency catheter ablation (RFCA) is a first-line therapeutic option for supraventricular tachycardia (SVT).(1) It is conventionally performed under fluoroscopy. The amount of exposure to fluoroscopy is highly dependent on multiple variables, such as operator experience and the complexity of the arrhythmia substrate.(2) As exposure to radiation during such procedures increases the lifetime risk of fatal malignancies, skin injuries and cataract, it poses a palpable hazard to both patients and medical staff.(3) This emphasises the importance of employing all possible measures to minimise exposure to ionising radiation.Recent advances in technology have led to the development of non-fluoroscopic three-dimensional (3D) mapping systems to guide ablation during prolonged electrophysiological procedures, such as pulmonary vein isolation for atrial fibrillation and mapping of atypical atrial flutter and ventricular tachycardia. These 3D mapping systems help physicians to better comprehend complex arrhythmias and develop appropriate ablation strategies. These systems have also been proven to substantially reduce ionising radiation exposure. Data on the use of non-fluoroscopic systems (NFS) in Singapore is limited. Therefore, the aim of the present study was to determine the consistency and applicability of the aforementioned latest findings in our local setting. The specific aims of the present study were (a) to determine the procedure and fluoroscopy times, and ionising radiation exposure of patients who underwent RFCA for SVT using NFS as compared to those using conventional fluoroscopy (CF); and (b) to compare atrioventricular nodal reentrant tachycardia (AVNRT) ablation and atrioventricular reentrant tachycardia (AVRT) ablation. METHODSThe present study was a prospective analysis of patients who underwent electrophysiology (EP) study of paroxysmal SVT at our institution from January 2012 to March 2014. Patients with AVNRT and AVRT were enrolled and a total of 200 consecutive patients, aged 11-86 years, who underwent RFCA were included in this study. All patients (or parents, if the patient was underage) gave informed consent.Each patient underwent RFCA in the fasted and non-absorptive state, and under intravenous sedation with midazolam and fentanyl. Local anaesthetic with lignocaine was administered at the vascular access sites, which were the femoral venous site for all patients. Some patients also had femoral arterial access if the operator selected a retrograde aortic approach to obtain access to the left side of the heart. The decision for NFS usage was operator-dependent and made before the EP study. The choice of NFS, either EnSite TM NavX

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“Near-zero” fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX™ mapping system: personal experience and review of the literature

Cited by 92 publications

References 27 publications

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

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

Reduction of Fluoroscopic Exposure Using a New Fluoroscopy Integrating Technology in a 3D-Mapping System During Pulmonary Vein Isolation With a Circular Multipolar Irrigated Catheter

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

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