Near-zero x-ray in arrhythmia ablation using a 3-dimensional electroanatomic mapping system: A multicenter experience

Giaccardi, Marzia; Rosso, Attilio Del; Guarnaccia, Vincenzo; Ballo, Piercarlo; Mascia, Giuseppe; Chiodi, Leandro; Colella, Andrea

doi:10.1016/j.hrthm.2015.09.003

Cited by 69 publications

(57 citation statements)

References 34 publications

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“…Second, in this small group of patients, there were no significant complications, though the technique should be validated and refined in larger cohorts in the future. Additionally, the TSP fluoroscopy times in this small group of patients were higher than previously reported values; 5,9,10,12 this may be due to the assistance of general cardiology fellows, who generally require longer fluoroscopy times for TSP than an experienced cardiologist, and the addition of patients with either paroxysmal or persistent AF, the latter of which may require longer procedure times and fluoroscopy use.…”

Section: Discussioncontrasting

confidence: 56%

“…4–7,9–13,15–19 Kühne et al advocate using transesophageal echocardiography (TEE) prior to TSP access, 10 whereas several groups describe intra-procedural TEE-guided TSP access with a high degree (97–100%) of AF-free event rates during respective follow-up periods. 13,16,17 Other groups have described TEE-guided TSP in combination with fluoroscopy to minimise radiation exposure, however reported outcomes from this approach demonstrated comparatively reduced AF-free success rates (75–85%).…”

Section: Discussionmentioning

confidence: 99%

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Fluoroscopy-free Atrial Transseptal Puncture

McCauley¹,

Patel²,

Greenberg³

et al. 2016

European Journal of Arrhythmia &Amp; Electrophysiology

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Introduction Fluoroscopy is traditionally used in atrial transseptal puncture (TSP); however fluoroscopy exposes patient and physician to excess radiation. Here, we describe a feasibility study of a zero-fluoroscopy transseptal puncture (ZFTSP) technique utilising electroanatomical mapping (EAM) and intracardiac echo (ICE) in a small case series of patients undergoing ablation for atrial fibrillation (AF). We then compare this technique to other established ZFTSP techniques for paroxysmal AF ablation. Methods Seven patients received ZFTSP. An Acunav™ ICE catheter (Biosense Webster Inc., California, US) was placed in the right atrium, then an Agilis™ sheath (St. Jude Medical, Saint Paul, Minnesota, US) was established into the inferior vena cava. A ThermoCool® SmartTouch™ catheter (Biosense Webster Inc., California, US) was inserted through the Agilis to map the fossa ovalis. Mapping catheter exchange for dilator and needle allowed for facile ZFTSP. AF outcome, fluoroscopy times, and procedure times were compared with eight age-matched control patients. Results There were no significant differences in age, body mass index (BMI) or AF duration between the two groups and no immediate complications. ZFTSP procedure time was 183.9±33.7 minutes versus 293.13±129.9 minutes for TSP-only controls (p=0.05). Fluoroscopy time was 17.5±14.1 minutes in ZFTSP patients versus 73.4±50.3 minutes in controls (p=0.01). AF recurrence in ZFTSP patients was 14% versus 25% in controls. Conclusion ZFTSP utilising ICE and EAM is safe, effective, and time-efficient. There is a small but significant reduction in radiation exposure to patient and physician by the use of this technique.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Fluoroscopy-free Atrial Transseptal Puncture

McCauley¹,

Patel²,

Greenberg³

et al. 2016

European Journal of Arrhythmia &Amp; Electrophysiology

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“…Left‐sided chambers were reached by a transaortic approach as mentioned in the methods section and all cases were carried out without complications. NOPARTY trial was the first multicentre, randomized trial with a minimal fluoroscopic approach, but it was limited to SVT CA without the use of the transaortic retrograde approach . In contrast, our cases also included idiopathic ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

From near‐zero to zero fluoroscopy catheter ablation procedures

Santoro

Clemente

Baiocchi

et al. 2019

Cardiovasc electrophysiol

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Aims The use of electroanatomical mapping (EAM) systems can reduce radiation exposure (RX) and it can also completely eliminate the use of RX. Radiation exposure related to conventional radiofrequency ablation procedures can have a stochastic and deterministic effect on health. The main aim of this study was to evaluate the safety and feasibility of an entirely nonfluoroscopic approach to catheter ablation (CA) using EAM CARTO3. Methods In 2011 we started an RX‐minimization programme in all procedures using the CARTO system with the deliberate intention to not resort to the aid of RX unless strictly necessary. We divided procedures into two groups (group 1: from 2011 to 2013; group 2: from 2014 to 2017). The only exclusion criteria were the need for transseptal puncture, and nonidiopathic ventricular tachycardia (VT). Results From a total of 525 procedures, we performed CA entirely without RX in 78.5% of cases. From 2011 to 2013, we performed CA without RX in 38.5% of cases; from 2014 to 2017, we performed 96.2% of cases with zero RX. The use of RX was significantly reduced in group 2 (group 2: 1.4 ± 19.6 seconds vs group 1: 556.92 ± 520.76 seconds; P < .001). These differences were irrespective of arrhythmia treatment. There were no differences between the two groups in acute success, complications, or duration of procedures. Conclusion CA of supraventricular tachycardia and VT entirely without RX, guided by the CARTO system, is safe, feasible, and effective. After an adequate learning curve, CA can be performed entirely without RX.

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“…Tridimensional electroanatomic voltage mapping systems (EAMS) enable the anatomy of the heart to be reconstructed without fluoroscopy by tracking the position of the catheters in real time and creating voltage or activation mapping based on the recordings of intracardiac action potentials. These systems are widely used for studying the mechanism of arrhythmias and to reduce the need for X‐rays during ablation procedures . More recently, the use of EAMS has also been proposed for CRT device implantation, in order to reduce fluoroscopy time and the use of contrast dye and to provide useful information on CS electrical activation that can guide the placement of the LV lead .…”

Section: Introductionmentioning

confidence: 99%