Use of a New Non‐Fluoroscopic Three‐Dimensional Mapping System in Type I Atrial Flutter Ablation

Abstract

We studied 40 patients who underwent cavo-tricuspid isthmus ablation for typical counterclockwise atrial flutter with cooled tip catheters between 2001 and 2003. Complete bi-directional isthmus block was created in all patients. A new, three-dimensional (3D), non-fluoroscopic mapping system was used in 20 patients (test group), and conventional fluoroscopy in 20 others (conventional group), using anatomic and electrophysiologic criteria in both groups. We measured the total procedure, ablation procedure, and overall fluoroscopy times, and the total number of radiofrequency (RF) applications delivered in the two groups. The overall fluoroscopy time was shorter in the test group (mean 8.8 minutes, range 2-17 minutes) than the conventional group (29.7 minutes, range 12-57 minutes; P < 0.001). Though the overall procedure time was similar in both groups (92.5 +/- 28.6 minutes vs 106.5 +/- 20.9 minutes; P = 0.067) the ablation duration (25.1 +/- 6.6 minutes versus 43.3 +/- 19.6 minutes; P = 0.0051) and the total RF applications (10.6 +/- 9.4 versus 16.4 +/- 9.4; P = 0.044) were smaller in the test group. The use of a new, 3D non-fluoroscopic mapping system markedly reduced the fluoroscopy exposure during typical atrial flutter ablation. It was also associated with a significant reduction in ablation time and in the number of RF applications. Since atrial flutter ablation is one of the most frequently performed procedures, this system may significantly reduce the overall amount of radiation exposure in high-volume laboratories.

Exclusion of Fluoroscopy Use in Catheter Ablation Procedures: Six Years of Experience at a Single Center

“…Several randomized studies have compared the conventional completely fluoroscopic approach with the combined approach using various navigation systems (CARTO, Biosense Webster), LocaLisa (Medtronic Cardiorrhythm, Minneapolis, MN, USA) and NavX for right-sided SVT. 2,4,5,[17][18][19] All of these have shown a significant reduction in radiation exposure with the use of these systems without compromising efficacy or safety. Another, more recent, randomized study compared the conventional approach with fluoroscopy and its combination with CARTO, and with NavX, to guide the ablation of supraventricular tachycardias, finding a reduction in radiation with the use of both navigation systems although more with NavX.…”

A Zero‐Fluoroscopy Approach to Cavotricuspid Isthmus Catheter Ablation: Comparative Analysis of Two Electroanatomical Mapping Systems

“…However, ionizing radiation has harmful effects and the heavy protective clothing required causes cervical and lumbar problems in electrophysiologists, and both of these factors are a cause for concern . The use of electroanatomical systems has been found to reduce the fluoroscopic radiation doses required to perform effective cavotricuspid isthmus (CTI) ablation . Up until now, the Ensite‐NavX™ system (St. Jude Medical, St. Paul, MN, USA) has been the only electroanatomical system to allow the zero‐fluoroscopy approach because it could be used to monitor all catheters from the moment they are inserted into the patient's venous system .…”

Feasibility of Transseptal Puncture Using a Nonfluoroscopic Catheter Tracking System

“…This study introduces an approach for TS puncture by employing a nonfluoroscopic technique. The efficacy of MDG technology in reducing the radiation exposure for several EP procedures has previously been demonstrated for more complex electrophysiology procedures, including ablation for AF, ventricular tachycardia, and placement of left ventricular leads . Although this is a step forward toward reducing the radiation exposure in EP procedures, there are several limitations of this study.…”

“…The efficacy of MDG technology in reducing the radiation exposure for several EP procedures has previously been demonstrated for more complex electrophysiology procedures, including ablation for AF, ventricular tachycardia, and placement of left ventricular leads. [9][10][11][12][13] Although this is a step forward toward reducing the radiation exposure in EP procedures, there are several limitations of this study. This is a small observational study comprising the very early experience utilizing MDG-enabled guidewire.…”