Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study

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

doi:10.1016/j.hrthm.2015.05.018

Cited by 44 publications

(30 citation statements)

References 23 publications

(17 reference statements)

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“…showed that the systematic use of third generation mapping systems reduced fluoroscopy exposure in patients undergoing AF ablation, without increasing procedure duration or affecting safety and short-term efficacy 46 . Eventually the systematic use of electroanatomic mapping systems integrated with preacquired imaging, in this case cardiac magnetic resonance with use of oral gadobenate dimeglumine, 47 also presents the advantage of visualizing the esophagus in relation to points of radiofrequency delivery.…”

Section: Atrioventricular Re-entrant Tachycardia Reciprocating Atriomentioning

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: Atrioventricular Re-entrant Tachycardia Reciprocating Atriomentioning

confidence: 99%

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

et al. 2016

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“…For these reasons, current practice guidelines recommend minimizing fluoroscopy usage during AF ablation procedures to as low as reasonably achievable in the EP laboratory to limit radiation dose exposure 1,6 . Recently, numerous observational and randomized studies have explored the feasibility and safety of low and zero fluoroscopic radiofrequency (RF) approaches for PVI in comparison to conventional approaches, although all are single‐center studies and the majority have been observational 7‐21 . To better understand the generalizability of low fluoroscopy (LF) approaches for PVI for AF in clinical practice we conducted a meta‐analysis to derive comprehensive estimates of clinical efficacy, safety and procedural parameters between studies comparing low/zero fluoroscopy to conventional fluoroscopy (CF) approaches for PVI.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low‐ and zero‐fluoroscopy approaches

Huang

Abid

Ravi

et al. 2020

Cardiovasc electrophysiol

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Introduction: Radiation exposure during catheter ablation procedures is a significant hazard for both patients and operators. Atrial fibrillation (AF) ablation procedures have been historically associated with higher fluoroscopy usage than other electrophysiology procedures. Recent efforts have been made to reduce dependence on fluoroscopy during pulmonary vein isolation (PVI) ablation procedures using alternative techniques. Methods: We performed a meta-analysis of studies comparing zero or low fluoroscopy (LF) vs conventional fluoroscopy (CF) approaches for AF ablation. Outcomes of interest included acute and 12-month procedural efficacy, safety, procedure duration, fluoroscopy time, and dose area product. Aggregated data were analyzed with random-effects models, using a Bayesian hierarchical approach. Results: A total of 2228 participants (LF, n = 1190 vs CF, n = 1038) from 15 studies were included in the meta-analysis. Risk of AF recurrence in 12 months (odds ratio [OR], 95% confidence interval [95% CI] = 1.343 [0.771-2.340]; P = .297), redoablation procedures (OR [95% CI] = 0.521 [0.198-1.323]; P = .186), and procedural complications (OR [95% CI] = 0.99 [0.485-2.204]; P = .979) were similar between LF-and CF-ablation groups. In comparison to CF ablation, LF ablation led to shorter procedure duration (weighted mean differences [WMDs] [95% CI] = −14.6 minutes [−22.5 to −6.8]; P < .001), fluoroscopy time (WMD [95% CI] = −8.8 minutes [−11.9 to −5.9]; P < .001), and dose area product (WMD [95% CI] = −1946 mGy/cm 2 [−2685 to 1207]; P < .001). Conclusion: LF approaches have similar clinical efficacy and safety as CF approaches for PVI. LF approaches are associated with shorter procedure time, fluoroscopy usage, and dose area product during PVI. K E Y W O R D S atrial fibrillation, catheter ablation, fluoroscopy, pulmonary vein isolation

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“…Since the beginning of interventional electrophysiology for diagnosis and therapy of cardiac arrhythmias, fluoroscopy techniques have been widely used to navigate catheters within the heart and the vessels and to monitor their position. In recent years, technical developments have led to the routine and wide-spread use of non-fluoroscopic three-dimensional (3D) electro-anatomical navigation and mapping systems for radiofrequency ablation (RFA) of tachyarrhythmias including atrial fibrillation (AF) resulting in a significant reduction of radiation dose during mapping and ablation of complex arrhythmias [7][8][9][10][11][12]. Minimizing the exposure to radiation is recommended by the American College of Cardiology teaching the ALARA principlekeeping the radiation "as low as reasonably achievable" [13].…”

Section: Introductionmentioning

confidence: 99%