Visualizable vs. standard, non-visualizable steerable sheath for pulmonary vein isolation procedures: randomized, single-center trial

Janosi, K; Debreceni, Dorottya; Janosa, B; Símor, Tamás; Kupó, Péter

doi:10.1093/europace/euac053.276

Cited by 2 publications

(3 citation statements)

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“…Results from the current study are consistent with previous reports showing that the VIZIGO visualizable steerable sheath had similar safety to the Agilis non-visualizable sheath, 16 with shorter fluoroscopy times and lower fluoroscopy doses in patients undergoing PVI for the treatment of AF. 15 , 20 As was reported here, overall procedure time was similar between the visualizable and non-visualizable sheath groups in previous studies. 15 , 20 …”

Section: Discussionsupporting

confidence: 86%

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The impact of steerable sheath visualization during catheter ablation for atrial fibrillation

et al. 2023

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Aims Incorporating a steerable sheath that can be visualized using an electroanatomical mapping (EAM) system may allow for more efficient mapping and catheter placement, while reducing radiation exposure, during ablation procedures for atrial fibrillation (AF). This study evaluated fluoroscopy usage and procedure times when a visualizable steerable sheath was used compared with a non-visualizable steerable sheath for catheter ablation for AF. Methods and results In this retrospective, observational, single-centre study, patients underwent catheter ablation for AF using a steerable sheath that is visualizable using the CARTO EAM (VIZIGO; n = 57) or a non-visualizable steerable sheath (n = 34). The acute procedural success rate was 100%, with no acute complications in either group. Use of the visualizable sheath vs. the non-visualizable sheath was associated with a significantly shorter fluoroscopy time [median (first quartile, third quartile), 3.4 (2.1, 5.4) vs. 5.8 (3.8, 8.6) min; P = 0.003], significantly lower fluoroscopy dose [10.0 (5.0, 20.0) vs. 18.5 (12.3, 34.0) mGy; P = 0.015], and significantly lower dose area product [93.0 (48.0, 197.9) vs. 182.2 (124.5, 355.0) μGy·m2; P = 0.017] but with a significantly longer mapping time [12.0 (9.0, 15.0) vs. 9.0 (7.0, 11.0) min; P = 0.004]. There was no significant difference between the visualizable and non-visualizable sheaths in skin-to-skin time [72.0 (60.0, 82.0) vs. 72.0 (55.5, 80.8) min; P = 0.623]. Conclusion In this retrospective study, use of a visualizable steerable sheath for catheter ablation of AF significantly reduced radiation exposure vs. a non-visualizable steerable sheath. Although mapping time was longer with the visualizable sheath, the overall procedure time was not increased.

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Section: Discussionsupporting

confidence: 86%

“… 15 , 20 As was reported here, overall procedure time was similar between the visualizable and non-visualizable sheath groups in previous studies. 15 , 20 …”

Section: Discussionsupporting

confidence: 86%

The impact of steerable sheath visualization during catheter ablation for atrial fibrillation

et al. 2023

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“…Numerous studies have confirmed the feasibility of near-zero and zero-fluoroscopy approaches for CTI ablation, including their successful application as an extension to pulmonary vein isolation procedures within a single session (5,(15)(16)(17)(18)(19)(20)(21)(22)(23). In addition, the advent of visualizable steerable sheaths has yielded significant advancements in mitigating radiation exposure during catheter ablation procedures (24).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial

Debreceni,

Janosi,

Turcsan

et al. 2023

Front. Cardiovasc. Med.

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IntroductionCatheter ablation is the preferred treatment for typical atrial flutter (AFl), but it can be challenging due to anatomical abnormalities. The use of 3D electroanatomical mapping systems (EAMS) has reduced fluoroscopy exposure during AFl ablation. Intracardiac echocardiography (ICE) has also shown benefits in reducing radiation exposure during AFl ablation. However, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS.MethodsIn this prospective study, we enrolled 80 patients with CTI-dependent AFl. The first 40 patients underwent standard fluoroscopy + ICE-guided ablation (Standard ICE group), while the other 40 patients underwent zero-fluoroscopy ablation using only ICE (Zero ICE group). Procedure outcomes, including acute success, procedure time, fluoroscopy time, radiation dose, and complications, were compared between the groups.ResultsThe acute success rate was 100% in both groups. Out of the 40 cases, the zero-fluoroscopy strategy was successfully implemented in 39 cases (97.5%) in the Zero ICE group. There were no significant differences in procedure time [55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p = 0.50] and puncture to first ablation time [18 (13.5; 23) min vs. 19 (15; 23.5) min, p = 0.50] between the groups. The Zero ICE group had significantly lower fluoroscopy time [57 (36.3; 90) sec vs. 0 (0; 0) sec, p < 0.001] and dose [3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p < 0.001] compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group [597 (447; 908) sec vs. 430 (260; 750), p = 0.02], but total ablation energy [22,458 (14,836; 31,116) Ws vs. 17,043 (10,533; 29,302) Ws, p = 0.10] did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were similar between the groups. No complications or recurrences were observed during the follow-up period.ConclusionOur study suggests that zero-fluoroscopy CTI ablation guided solely by ICE for AFl is feasible and safe. Further investigation is warranted for broader validation.

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Visualizable vs. standard, non-visualizable steerable sheath for pulmonary vein isolation procedures: randomized, single-center trial

Cited by 2 publications

References 0 publications

The impact of steerable sheath visualization during catheter ablation for atrial fibrillation

The impact of steerable sheath visualization during catheter ablation for atrial fibrillation

Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial

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