Laurent M Haegeli1,2, Linda Stutz3, Mohammed Mohsen3, Thomas Wolber3, Corinna Brunckhorst3, Chol-Jun On3, Firat Duru3. 1. Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland. laurent.haegeli@usz.ch. 2. Division of Cardiology, Medical University Department, Kantonsspital Aarau, Switzerland. laurent.haegeli@usz.ch. 3. Arrhythmia and Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.
Abstract
BACKGROUND: Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a "real world" experience of a single tertiary care center. METHODS: This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE). RESULTS: Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy. CONCLUSIONS: This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a "real world" experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.
BACKGROUND: Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a "real world" experience of a single tertiary care center. METHODS: This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE). RESULTS: Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AFpatients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AFpatients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy. CONCLUSIONS: This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a "real world" experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.
Authors: K Perisinakis; J Damilakis; N Theocharopoulos; E Manios; P Vardas; N Gourtsoyiannis Journal: Circulation Date: 2001-07-03 Impact factor: 29.690
Authors: M C Limacher; P S Douglas; G Germano; W K Laskey; B D Lindsay; M H McKetty; M E Moore; J K Park; F M Prigent; M N Walsh Journal: J Am Coll Cardiol Date: 1998-03-15 Impact factor: 24.094
Authors: John D Ferguson; Adam Helms; J Michael Mangrum; Srijoy Mahapatra; Pamela Mason; Ken Bilchick; George McDaniel; David Wiggins; John P DiMarco Journal: Circ Arrhythm Electrophysiol Date: 2009-12
Authors: Gerhard Hindricks; Stefan Willems; Josef Kautzner; Christian De Chillou; Michael Wiedemann; Siep Schepel; Christopher Piorkowski; Tim Risius; Hans Kottkamp Journal: J Cardiovasc Electrophysiol Date: 2009-07
Authors: Michael Kühne; Sven Knecht; Aline Mühl; Tobias Reichlin; Nikola Pavlović; Arnheid Kessel-Schaefer; Beat A Kaufmann; Beat Schaer; Christian Sticherling; Stefan Osswald Journal: PLoS One Date: 2016-01-28 Impact factor: 3.240
Authors: Anil Rajendra; Tina D Hunter; Gustavo X Morales; Paul Zei; Lee Ming Boo; Allyson Varley; Jose Osorio Journal: J Interv Card Electrophysiol Date: 2022-08-10 Impact factor: 1.759
Authors: Matevž Jan; David Žižek; Dimitrij Kuhelj; Nikola Lakič; Tine Prolič Kalinšek; Jernej Štublar; Luka Klemen; Andrej Pernat; Bor Antolič Journal: Int J Cardiovasc Imaging Date: 2019-11-11 Impact factor: 2.357
Authors: Grzegorz Karkowski; Marcin Kuniewicz; Edward Koźluk; Tomasz Chyży; Andrzej Ząbek; Michał Dusza; Jacek Lelakowski Journal: Postepy Kardiol Interwencyjnej Date: 2020-10-02 Impact factor: 1.426