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Osorio J, Miranda-Arboleda AF, Velasco A, Varley AL, Rajendra A, Morales GX, Hoyos C, Matos C, Thorne C, D'Souza B, Silverstein JR, Metzl MD, Hebsur S, Costea AI, Kang S, Sellers M, Singh D, Salam T, Nazari J, Ro AS, Mazer S, Moretta A, Oza SR, Magnano AR, Sackett M, Dukes J, Patel P, Goyal SK, Senn T, Newton D, Romero JE, Zei PC. Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry. Heart Rhythm 2024:S1547-5271(24)02524-4. [PMID: 38768839 DOI: 10.1016/j.hrthm.2024.04.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed. OBJECTIVE The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months. RESULTS A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%. CONCLUSION Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.
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Affiliation(s)
- Jose Osorio
- HCA Electrophysiology, Mercy Hospital, Miami, Florida
| | | | - Alejandro Velasco
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | | | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama
| | | | | | - Carlos Matos
- Brigham and Women`s Hospital, Boston, Massachusetts
| | | | - Benjamin D'Souza
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Kang
- Sutter Alta Bates Summit Medical Center, Oakland, California
| | | | | | - Tariq Salam
- Pulse Heart Institute/Multicare, Tacoma, Washington
| | | | | | - Sean Mazer
- New Mexico Heart Institute, Albuquerque, New Mexico
| | | | | | | | | | | | - Parin Patel
- Ascension Medical Group, Indianapolis, Indiana
| | | | | | | | | | - Paul C Zei
- Brigham and Women`s Hospital, Boston, Massachusetts.
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Luke K, Milla C, Tandi JK, Julario R. Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta-analysis. J Arrhythm 2024; 40:38-46. [PMID: 38333407 PMCID: PMC10848632 DOI: 10.1002/joa3.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 02/10/2024] Open
Abstract
Background Fluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults. Method A systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023. All observational or experimental studies comparing ZMF approach to fluoroscopy for adult CIEDs therapy were included. Reviews, case report/series, animal studies, and non-English articles were excluded. The success rate, procedural time, fluoroscopy time, radiation dose, and complications rate were compared for each approach. Results Seven articles for permanent and three articles for temporary CIEDs were included for analysis. The success rate of ZMF for permanent CIEDs was similar to fluoroscopy method (OR: 0.77, 95% CI: 0.33-4.15). The procedural time of ZMF was similar to fluoroscopy for both permanent and temporary CIEDs (standardized mean difference [SMD]: 0.10, 95% CI: -0.35 to 0.55 and SMD: -0.71, 95% CI: -1.87-0.44, respectively). However, ZMF approach markedly reduced the fluoroscopy time and radiation exposure for permanent CIEDs (SMD: -1.80, 95% CI: -2.49 to -1.12 and SMD: -1.26, 95% CI: -2.24 to -0.29). The complication rate was similar for permanent CIEDs (OR: 1.08, 95% CI: 0.41-2.84), yet lowered for temporary CIEDs (OR: 0.34, 95% CI: 0.20-0.59). Conclusion ZMF had similar success rate, procedural time, and sum complication rate for permanent CIEDs implantation with a significant reduction of fluoroscopy time and radiation exposure.
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Affiliation(s)
- Kevin Luke
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Clonia Milla
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | | | - Rerdin Julario
- Department of Cardiology and Vascular MedicineDr. Soetomo General Hospital‐Universitas AirlanggaSurabayaIndonesia
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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Melero-Polo J, Cabrera-Ramos M, Alfonso-Almazán JM, Marín-García I, Montilla-Padilla I, Ruiz-Arroyo JR, López-Rodríguez G, Ramos-Maqueda J. Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach. Front Cardiovasc Med 2024; 10:1322743. [PMID: 38239876 PMCID: PMC10794657 DOI: 10.3389/fcvm.2023.1322743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. Methods We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. Results A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. Conclusions LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.
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Affiliation(s)
- Jorge Melero-Polo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | | | - Isabel Montilla-Padilla
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | - Javier Ramos-Maqueda
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
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5
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Ozcan EE, Turan OE, Yilancioğlu RY, Inevi U, Akdemir B. Combining conventional technique with fluoroscopy integration module in accessory pathway ablation. J Cardiovasc Electrophysiol 2023; 34:2573-2580. [PMID: 37890039 DOI: 10.1111/jce.16110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Accessory pathway (AP) ablation is a straightforward approach with high success rates, but the fluoroscopy time (FT) is significantly longer in conventional technique. Electroanatomical mapping systems (EMS), reduce the FT, but anatomical and activation mapping may prolong the procedure time (PT). The fluoroscopy integration module (FIM) uses prerecorded fluoroscopy images and allows ablation similar to conventional technique without creating an anatomical map. In this study, we investigated the effects of combining the FIM with traditional technique on PT, success, and radiation exposure. METHODS A total of 131 patients who had undergone AP ablation were included in our study. In 37 patients, right and left anterior oblique (RAO-LAO) images were acquired after catheter placement and integrated with the FIM. The ablation procedure was then similar to the conventional technique, but without the use of fluoroscopy. For the purpose of acceleration, anatomical and activation maps have not been created. Contact-force catheters were not used. 94 patients underwent conventional ablation using fluoroscopy only. RESULTS FIM into AP ablation procedures led to a significant reduction in radiation exposure, lowering FT from 7.4 to 2.8 min (p < .001) and dose-area product from 12.47 to 5.8 μGym² (p < .001). While the FIM group experienced a reasonable longer PT (69 vs. 50 min p < .001). FIM reduces FT regardless of operator experience and location of APs CONCLUSION: Combining FIM integration with conventional AP ablation offers reduced radiation exposure without compromising success rates and complication.
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Affiliation(s)
- Emin Evren Ozcan
- Department of Cardiology, Heart Rhythm Management Centre, Dokuz Eylul University, Izmir, Turkiye
| | - Oğuzhan Ekrem Turan
- Department of Cardiology, Heart Rhythm Management Centre, Dokuz Eylul University, Izmir, Turkiye
| | - Reşit Yiğit Yilancioğlu
- Department of Cardiology, Heart Rhythm Management Centre, Dokuz Eylul University, Izmir, Turkiye
| | - Umut Inevi
- Ege Aritmi Medical Product and Engineering, Izmir, Turkey
| | - Barış Akdemir
- Department of Cardiology, Yeni Yuzyil University, Istanbul, Turkey
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6
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Soether C, Boehmer AA, Dobre BC, Kaess BM, Ehrlich JR. Zero-fluoro atrioventricular-nodal reentrant tachycardia ablation. Herzschrittmacherther Elektrophysiol 2023; 34:305-310. [PMID: 37950109 DOI: 10.1007/s00399-023-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger patients. The treatment of choice is radiofrequency catheter ablation (RFCA), traditionally necessitating ionizing radiation for catheter guidance. OBJECTIVE The authors aimed to demonstrate the feasibility and safety of zero-fluoroscopy RFCA of AVNRT using EnSite™ NavX™ as a three-dimensional (3D) electroanatomical mapping system (EAM). METHODS The authors retrospectively analyzed 68 patients that underwent AVNRT-RFCA. One group was a priori allocated to conventional fluoroscopy mapping (convFluoro, n = 30). In 38 cases, the electrophysiologist chose to use 3D-EAM for ablation. Of these patients, 20 could be ablated without fluoroscopy use (zeroFluoro). In 18 cases that were initially intended as 3D-EAM, additional fluoroscopy use was necessary due to difficult anatomic conditions (convertedFluoro). Procedure duration, fluoroscopy duration and dose, as well as complications were analyzed. RESULTS Procedure duration was similar for the convFluoro and zeroFluoro groups (74 ± 24 min vs. 80 ± 26 min, p = ns). The convertedFluoro group showed longer procedure duration compared to the convFluoro group (94 ± 30 min vs. 74 ± 24 min, p < 0.05). The use of 3D-EAM significantly reduced fluoroscopy duration comparing the convFluoro with the convertedFluoro group (12 ± 9 min vs. 7 ± 6 min, p < 0.05). The difference in fluoroscopy dose between convFluoro and convertedFluoro did not reach significance (169 ± 166 cGycm2 vs. 134 ± 137 cGycm2, p = ns). In zeroFluoro cases, no radiation was used at all. 3D-EAM-guided RFCA was primarily successful in all patients. Overall, there were only few minor complications in the different groups. No major complications occurred. CONCLUSION Zero-fluoro RFCA in patients with AVNRT is feasible and safe. 3D-EAM can reduce radiation exposure in the majority of patients without prolonging procedure duration or increasing complications.
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Affiliation(s)
- Christina Soether
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Andreas A Boehmer
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bianca C Dobre
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bernhard M Kaess
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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Topalović M, Jan M, Kalinšek TP, Žižek D, Štublar J, Rus R, Kuhelj D. Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1513. [PMID: 37761474 PMCID: PMC10527735 DOI: 10.3390/children10091513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Catheter ablation (CA) of supraventricular tachycardias (SVTs) is conventionally performed with the aid of X-ray fluoroscopy. Usage of a three-dimensional (3D) electro-anatomical mapping (EAM) system and intracardiac echocardiography (ICE) enables zero-fluoroscopy ablation, eliminating the harmful effects of radiation. We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Overall, in 171 consecutive patients (12.5 ± 3.9 years), 175 SVTs were diagnosed and 201 procedures were performed. The procedural success rate was 98% (193/197), or more precisely, 100% (86/86) for AVNRT, 95.8% (91/95) for AVRT, 94.1% (16/17) for AT and 100% (2/2) for AFL. No complications were recorded. Follow-up was complete in 100% (171/171) of patients. During the mean follow-up period of 488.4 ± 409.5 days, 98.2% of patients were arrhythmia-free with long-term success rates of 98.7% (78/79), 97.5% (78/80), 100% (13/13) and 100% (2/2) for AVNRT, AVRT, AT and AFL, respectively. Zero-fluoroscopy CA of various types of SVTs in the pediatric population is a feasible, effective and safe treatment option.
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Affiliation(s)
- Mirko Topalović
- Cardiology Department, Pediatric Clinic, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Matevž Jan
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - David Žižek
- Cardiology Department, Internal Medicine Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
| | - Jernej Štublar
- Cardiovascular Surgery Department, Surgical Clinic, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia (T.P.K.); (J.Š.)
| | - Rina Rus
- Cardiology Department, Pediatric Clinic, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia;
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Adeliño R, Malaczynska-Rajpold K, Perrotta L, Manninger M, Vanduynhoven P, Nesti M, Goanță EV, Waldmann V, Pavlovic N, Farkowski MM, Guerra JM, Penela D, Boveda S, Chun JKR. Occupational radiation exposure of electrophysiology staff with reproductive potential and during pregnancy: an EHRA survey. Europace 2023; 25:euad216. [PMID: 37498147 PMCID: PMC10401324 DOI: 10.1093/europace/euad216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
AIMS Electrophysiology (EP) is a growing field in cardiology, with an increasing involvement of young people. Nevertheless, concerns about radiation exposure and its impact on reproduction and pregnancy may discourage the choice of an EP career. The study is aimed at investigating the level of awareness and main sources of concern about the effects of radiation on reproductive potential and pregnancy, exploring the safety measures adopted in different EP labs, and verifying the adherence to the current guidelines. METHODS AND RESULTS An online survey was conducted using the European Heart Rhythm Association (EHRA) infrastructure from April to June 2022. A total of 252 EP personnel (42% women) participated, from 50 countries and different professional roles. Most participants expressed concerns regarding the effects of radiation on reproductive capacity (67.1%) and offspring diseases (68.2%). Only 37.9% of participants were aware of the EHRA 2017 consensus document about occupational radiation exposure. Most participants (80.9%) considered that occupational radiation during pregnancy is not safe. EP female staff were not allowed to work in the EP lab during pregnancy in 48.1% of cases. Zero-fluoroscopy was the preferred choice to continue working in the EP lab during pregnancy. CONCLUSION EP staff, including both men and women, have concerns about the effects of radiation on reproductive capacity. Despite the recommendations issued by international bodies, implementation of the policies regarding pregnancy and occupational radiation exposure is heterogeneous. Zero-fluoroscopy is the preferred approach to ensure safety during pregnancy in the EP lab.
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Affiliation(s)
- Raquel Adeliño
- Arrhythmia Unit, Cardiology Department, Vall d’Hebron University Hospital, Pg. de la Vall d'Hebron 119, 08035 Barcelona, Spain
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | | | - Laura Perrotta
- Arrhythmia Unit, Department of Cardiothoracovascular Medicine, Careggi University Hospital, Largo Giovanni Alessandro Brambilla, 3, 50134 Florence, Italy
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
| | - Philippe Vanduynhoven
- Department of Cardiology, Arrhythmia Clinic, Algemeen Stedelijk Ziekenhuis Aalst, Merestraat 80, 9300 Aalst, Belgium
| | - Martina Nesti
- Arrhythmia Unit, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, 56124 Pisa, Italy
| | - Emilia-Violeta Goanță
- Cardiology Department, ‘Victor Babes’ University of Medicine and Pharmacy, 2 Eftimie Murgu 2, Timisoara 300041, Romania
| | - Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20 Rue Leblanc, 75015 Paris, France
| | - Nikola Pavlovic
- Department of Cardiology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí, 89, 08025 Barcelona, Spain
- Universidad Autonoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Cardiovascular Disease Networking Biomedical Research Center (CIBERCV), Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Vilana nº 12, 08022 Barcelona, Spain
| | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez - BP 27617 - 31076, 31300 Toulouse, France
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Im Prüfling 23, 60389 Frankfurt am Main, Germany
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9
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Steerable sheath visualizable under 3D electroanatomical mapping facilitates paroxysmal atrial fibrillation ablation with minimal fluoroscopy. J Interv Card Electrophysiol 2023; 66:381-388. [PMID: 35947317 PMCID: PMC9977702 DOI: 10.1007/s10840-022-01332-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Advances in technology and workflows have facilitated substantial reductions in fluoroscopy utilization and procedure times for atrial fibrillation (AF) ablations. A recently available steerable sheath, visualizable on a 3D electroanatomical map (EAM), may further simplify low/zero fluoroscopy ablation workflows by facilitating understanding of the relative positions of the catheter and sheath. The objective of this study was to demonstrate feasibility, safety, procedural efficiency, and clinical effectiveness of incorporating the new visualizable sheath into a low-fluoroscopy workflow. METHODS Consecutive de novo paroxysmal AF procedures were performed with a porous tip contact force catheter at a high-volume site between January 2018 and May 2019. Procedures performed with and without the VIZIGO™ EAM-visualizable sheath (Vizigo) were compared. All ablations employed the same standardized low-fluoroscopy workflow. Statistical analyses employed stabilized inverse probability of treatment weights (IPTW) to balance cohorts by operator and key patient characteristics. RESULTS Cohorts of 142 Vizigo and 173 non-Vizigo patients were similar at baseline. Use of the Vizigo sheath was associated with approximately 10% improvement in catheter stability (p = 0.0005), 16% reduction in radiofrequency time (p < 0.0001), and 7% fewer ablations that used fluoroscopy (p = 0.0030). There was one cardiac tamponade in each cohort and no deaths, atrioesophageal fistulas, or strokes. Single-procedure freedom from atrial arrhythmia recurrence through 12 months was similar between cohorts (p = 0.9556). CONCLUSIONS Use of a 3D EAM-visualizable sheath resulted in improved catheter stability, reduced radiofrequency time, and more procedures performed without fluoroscopy, without compromise to safety or effectiveness.
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Świętoniowska-Mścisz A, Stec P, Stec S, Szydłowski L, Zagrodzka M, Kusa J, Morka A, Kameczura T, Mścisz A, Anna Stec-Gola, Karbarz D, Śledź J. Efficacy and safety of zero-fluoroscopy approach for ablation of atrioventricular nodal reentry tachycardia: experience from more than 1000 cases. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01419-2. [DOI: 10.1007/s10840-022-01419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 11/04/2022] [Indexed: 12/14/2022]
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11
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Lemke L, El Hamriti M, Braun M, Baridwan N, Sciacca V, Fink T, Khalaph M, Guckel D, Eitz T, Sohns C, Sommer P, Imnadze G. AV-node isolation as an alternative to AV-node ablation in patients undergoing pace & ablate strategy. J Cardiovasc Electrophysiol 2022; 33:2606-2613. [PMID: 36218022 DOI: 10.1111/jce.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Atrioventricular (AV)-node ablation (AVNA) is a common therapy option for rate control strategy of permanent atrial fibrillation (AF). We hypothesized that isolation of the AV nodal isolation (AVNI) is associated with a more frequent preservation of an adequate escape rhythm compared to AVNA. METHODS This retrospective study included 20 patients with therapy-refractory AF being treated with AVNI and 40 historical AVNA-controls. In AVNI the AV-node region was mapped using a 3D mapping system. Ablation was performed around the previously mapped HIS-cloud regions isolating the atrium from the AV-node. In the AVNI group, ablation was performed with irrigated tip ablation catheter in all cases. The two approaches were compared regarding rate of escape rhythm, delta QRS, and procedural data. RESULTS The number of patients with adequate escape rhythm in AVNI was significantly superior to AVNA immediately postoperative (90% vs. 40%, p < 0.01) and during follow-up (77% vs. 36%, p < 0.05). The median change in QRS width was 0 ms in AVNI versus +26 ms in AVNA (p < 0.01). Thirty percent new bundle branch blocks in AVNA were observed compared to 0% in AVNI (p < 0.01). In the AVNI group, fluoroscopy time and total dose area product were significantly lower (p < 0.01). CONCLUSION The present study suggests that AV-node isolation using 3D navigation mapping system is a feasible and effective alternative to conventional AVNA. The precise application of radiofrequency lesions preserves a stable AV-junctional rhythm.
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Affiliation(s)
- Lisa Lemke
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Nafilah Baridwan
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Denise Guckel
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Eitz
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Hoshiyama T, Sumi H, Kaneko S, Kawahara Y, Ito M, Kanazawa H, Takashio S, Yamamoto E, Matsushita K, Tsujita K. Placement of catheters without magnetic sensors in the coronary sinus without fluoroscopic guidance: Feasibility and safety evaluation. J Arrhythm 2022; 38:736-742. [PMID: 36237862 PMCID: PMC9535797 DOI: 10.1002/joa3.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/25/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022] Open
Abstract
Background A three‐dimensional (3D) mapping system is essential to reduce radiation exposure during catheter ablation. When using the CARTO 3D mapping system, only the catheter with magnetic sensor can visualize its location. However, once target chamber matrix is created using the catheter, even the catheters without magnetic sensors (CWMS) can enable visualization. We aimed to investigate the feasibility and safety of placing a CWMS in the coronary sinus (CS) without fluoroscopic guidance. Methods The study group comprised 88 consecutive patients who underwent catheter ablation. CWMS placement was performed without fluoroscopic guidance in 47 patients and with fluoroscopic guidance in 41 patients. Placement without fluoroscopic guidance was performed after creating a visualization matrix of the CS, right atrium, and superior vena cava using a catheter with a magnetic sensor. Feasibility and safety were compared between the two groups. Results Successful catheter placement was achieved in all patients without fluoroscopic guidance, with no inter‐group difference in the median procedure time: with guidance, 120.0 [96.0–135.0] min, and without guidance, 110.0 [97.5–125.0] min; p = .22. However, radiation exposure was significantly shorter, and the effective dose was lower without fluoroscopic guidance (0 [0–17.5] s and 0 [0–0.004] mSv, respectively) than with fluoroscopic guidance (420.0 [270.0–644.0] s and 0.73 mSv [0.36–1.26], respectively); both p < .001. Conclusions CWMS placement without fluoroscopic guidance is feasible, safe to perform, and does not involve complications. Our technique provides an option to decrease radiation exposure during catheter ablation and electrophysiological testing.
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Affiliation(s)
- Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Hitoshi Sumi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Shozo Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Yusei Kawahara
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Miwa Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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Debreceni D, Janosi K, Vamos M, Komocsi A, Simor T, Kupo P. Zero and Minimal Fluoroscopic Approaches During Ablation of Supraventricular Tachycardias: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:856145. [PMID: 35479287 PMCID: PMC9037593 DOI: 10.3389/fcvm.2022.856145] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. To guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches have become available, using three-dimensional electroanatomical mapping systems. Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardia (SVT). Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing electrophysiology (EP) procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RRs) with 95% confidence interval (CI). Results Twenty-four studies involving 9,074 patients met our inclusion criteria. There was no difference between the groups in terms of acute success rate (RR = 1.00, 95% CI, 0.99–1.01; p = 0.97) and long-term success rate (RR: 1.01, 95% CI, 1.00–1.03; p = 0.13). Compared to the conventional method, zero-and-minimal fluoroscopy (Z/MF) ablation significantly reduced fluoroscopic time [MD: −1.58 min (95% CI, −2.21 to −0.96 min; p < 0.01)] and ablation time [MD: −25.23 s (95% CI: −42.04 to −8.43 s; p < 0.01)]. No difference could be detected between the two groups in terms of the procedure time [MD: 3.06 min (95% CI: −0.97 to 7.08; p = 0.14)] and the number of ablation applications [MD: 0.13 (95% CI: −0.86 to 1.11; p = 0.80)]. The complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95% CI: 0.45–1.05; p = 0.08). Conclusions The Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time without compromising the acute and long-term success or complication rates.
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Affiliation(s)
- Dorottya Debreceni
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
- *Correspondence: Dorottya Debreceni
| | - Kristof Janosi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andras Komocsi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Tamas Simor
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
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Conventional fluoroscopy-guided versus zero-fluoroscopy catheter ablation of supraventricular tachycardias. BMC Cardiovasc Disord 2022; 22:98. [PMID: 35282836 PMCID: PMC8919640 DOI: 10.1186/s12872-022-02544-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/02/2022] [Indexed: 12/26/2022] Open
Abstract
Abstract
Purpose
The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT).
Methods
584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared.
Results
The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0%; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators' preferences.
Conclusion
The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.
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Rubenstein DS, Holmes BB, Manfredi JA, McKillop MS, Netzler PC, Ward CC. Aegrescit medendo: orthopedic disability in electrophysiology - call for fluoroscopy elimination-review and commentary. J Interv Card Electrophysiol 2022; 64:239-253. [PMID: 35258751 PMCID: PMC9236987 DOI: 10.1007/s10840-022-01173-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Donald S Rubenstein
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA.
| | - Benjamin B Holmes
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Joseph A Manfredi
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Matthew S McKillop
- Baptist Medical Center Jacksonville, 800 Prudential Dr., Jacksonville, FL, 32207, USA
| | - Peter C Netzler
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
| | - Chad C Ward
- Carolina Cardiology Consultants-EP Division, Prisma Health, 701 Grove Rd., Greenville, SC, 29605, USA
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Zero-fluoroscopy ablation of left-sided arrhythmia substrates in children – Mid-term safety and feasibility study from transaortic approach. J Formos Med Assoc 2022; 121:2035-2043. [DOI: 10.1016/j.jfma.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022] Open
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Ramos-Maqueda J, Álvarez M, Cabrera-Ramos M, Perin F, Rodríguez-Vázquez Del Rey MDM, Jiménez-Jaimez J, Macías-Ruiz R, Molina-Lerma M, Sánchez-Millán P, Tercedor-Sánchez L. Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:166-173. [PMID: 33741288 DOI: 10.1016/j.rec.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. METHODS We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). RESULTS We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). CONCLUSIONS The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.
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Affiliation(s)
- Javier Ramos-Maqueda
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Miguel Álvarez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Mercedes Cabrera-Ramos
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Francesca Perin
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Servicio de Pediatría, Hospital Materno Infantil Virgen de las Nieves, Granada, Spain
| | | | - Juan Jiménez-Jaimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rosa Macías-Ruiz
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Manuel Molina-Lerma
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Sánchez-Millán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Luis Tercedor-Sánchez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Ramos-Maqueda J, Álvarez M, Cabrera-Ramos M, Perin F, Rodríguez-Vázquez del Rey MDM, Jiménez-Jaimez J, Macías-Ruiz R, Molina-Lerma M, Sánchez-Millán P, Tercedor-Sánchez L. Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Randomized trial of intracardiac echocardiography-guided slow pathway ablation. J Interv Card Electrophysiol 2022; 63:709-714. [PMID: 35044581 DOI: 10.1007/s10840-022-01126-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Radiofrequency (RF) catheter ablation of the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT) is highly effective; however, it may require prolonged fluoroscopy and RF time. We postulated that visualization of the SP region with intracardiac echocardiography (ICE) could decrease ablation time, minimize radiation exposure, and facilitate SP ablation compared to the standard, fluoroscopy-guided approach. METHODS In our study, we randomized 91 patients undergoing electrophysiologic study and SP ablation for AVNRT into 2 groups: fluoroscopy-only (n = 48) or ICE-guided (n = 43) group. Crossover to ICE-guidance was allowed after 8 unsuccessful RF applications. RESULTS Mapping plus ablation time (mean ± standard deviation: 18.8 ± 16.1 min vs 11.6 ± 15.0 min, p = 0.031), fluoroscopy time (median [interquartile range]: 4.9 [2.93-8.13] min vs. 1.8 [1.2-2.8] min, p < 0.001), and total ablation time (144 [104-196] s vs. 81 [60-159] s, p = 0.001) were significantly shorter in the ICE group. ICE-guidance was associated with reduced radiation exposure (13.2 [8.2-13.4] mGy vs. 3.7 [1.5-5.8] mGy, p < 0.001). The sum of delivered RF energy (3866 [2786-5656] Ws vs. 2283 [1694-4284] Ws, p = 0.002) and number of RF applications (8 [4.25-12.75] vs. 4 [2-7], p = 0.001) were also lower with ICE-guidance. Twelve (25%) patients crossed over to the ICE-guided group. All were treated successfully thereafter with similar number, time, and cumulative energy of RF applications compared to the ICE group. No recurrence occurred during the follow-up. CONCLUSIONS ICE-guidance during SP ablation significantly reduces mapping and ablation time, radiation exposure, and RF delivery in comparison to fluoroscopy-only procedures. Moreover, early switching to ICE-guided ablation seems to be an optimal choice in challenging cases.
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 guideline focused update on non‐pharmacotherapy of cardiac arrhythmias. J Arrhythm 2022; 38:1-30. [PMID: 35222748 PMCID: PMC8851582 DOI: 10.1002/joa3.12649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H, Naito S, Yamane T, Kimura M, Shiga T, Soejima K, Noda T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Kohsaka S, Mitamura H. JCS/JHRS 2021 Guideline Focused Update on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:337-363. [PMID: 34987141 DOI: 10.1253/circj.cj-21-0162] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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Avazzadeh S, O’Brien B, Coffey K, O’Halloran M, Keane D, Quinlan LR. Establishing Irreversible Electroporation Electric Field Potential Threshold in A Suspension In Vitro Model for Cardiac and Neuronal Cells. J Clin Med 2021; 10:jcm10225443. [PMID: 34830725 PMCID: PMC8622402 DOI: 10.3390/jcm10225443] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022] Open
Abstract
Aims: Irreversible electroporation is an ablation technique being adapted for the treatment of atrial fibrillation. Currently, there are many differences reported in the in vitro and pre-clinical literature for the effective voltage threshold for ablation. The aim of this study is a direct comparison of different cell types within the cardiovascular system and identification of optimal voltage thresholds for selective cell ablation. Methods: Monophasic voltage pulses were delivered in a cuvette suspension model. Cell viability and live–dead measurements of three different neuronal lines, cardiomyocytes, and cardiac fibroblasts were assessed under different voltage conditions. The immediate effects of voltage and the evolution of cell death was measured at three different time points post ablation. Results: All neuronal and atrial cardiomyocyte lines showed cell viability of less than 20% at an electric field of 1000 V/cm when at least 30 pulses were applied with no significant difference amongst them. In contrast, cardiac fibroblasts showed an optimal threshold at 1250 V/cm with a minimum of 50 pulses. Cell death overtime showed an immediate or delayed cell death with a proportion of cell membranes re-sealing after three hours but no significant difference was observed between treatments after 24 h. Conclusions: The present data suggest that understanding the optimal threshold of irreversible electroporation is vital for achieving a safe ablation modality without any side-effect in nearby cells. Moreover, the evolution of cell death post electroporation is key to obtaining a full understanding of the effects of IRE and selection of an optimal ablation threshold.
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Affiliation(s)
- Sahar Avazzadeh
- Physiology and Cellular Physiology Research Laboratory, School of Medicine, Human Biology Building, National University of Ireland, H91 TK33 Galway, Ireland;
| | - Barry O’Brien
- AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 TK33 Galway, Ireland; (B.O.); (K.C.)
| | - Ken Coffey
- AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 TK33 Galway, Ireland; (B.O.); (K.C.)
| | - Martin O’Halloran
- Translational Medical Devise Lab, Lambe Institute of Translational Research, University College Hospital Galway, H91 TK33 Galway, Ireland;
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - David Keane
- Cardiac Arrhythmia Service, St Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
| | - Leo R. Quinlan
- Physiology and Cellular Physiology Research Laboratory, School of Medicine, Human Biology Building, National University of Ireland, H91 TK33 Galway, Ireland;
- CÚRAM SFI Centre for Research in Medical Devices, National University of Ireland, H91 TK33 Galway, Ireland
- Correspondence: ; Tel.: +353-91493710
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23
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Kwon HJ, Choi JH, Kim HR, Park SJ, Jeong DS, On YK, Kim JS, Park KM. Radiofrequency vs. Cryoballoon vs. Thoracoscopic Surgical Ablation for Atrial Fibrillation: A Single-Center Experience. MEDICINA-LITHUANIA 2021; 57:medicina57101023. [PMID: 34684060 PMCID: PMC8538093 DOI: 10.3390/medicina57101023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Cryoballoon ablation (CBA) and totally thoracoscopic surgical ablation (TTA) have emerged as alternatives to radiofrequency catheter ablation (RFCA) for atrial fibrillation. In this study, we describe our experience comparing patient characteristics and outcomes of RFCA, CBA, and TTA. Materials and Methods: We retrospectively analyzed data from patients who underwent RFCA, CBA, or TTA. Both atrial fibrillation (AF)- and atrial tachyarrhythmia (ATa)-free survival rates were compared using time to recurrence after a 3-month blanking period (defined by a duration of more than 30 s). All patients were regularly followed using 12-lead ECGs or Holter ECG monitoring. Results: Of 354 patients in this study, 125 underwent RFCA, 97 underwent CBA and 131 underwent TTA. The TTA group had more patients with persistent AF, a larger LA diameter, and a history of stroke. The CBA group showed the shortest procedure time (p < 0.001). The CBA group showed significantly lower AF-free survival at 12 months than the RFCA and TTA groups (RFCA 84%, CBA 74% and TTA 85%, p = 0.071; p = 0.859 for TTA vs. RFCA, p = 0.038 for RFCA vs. CBA and p = 0.046 for TTA vs. CBA). There were no significant differences in ATa-free survival among the three groups (p = 0.270). There were no procedure-related adverse events in the RFCA group, but some complications occurred in the CBA group and the TTA group (6% and 5%, respectively). Conclusions: RFCA and CBA are effective and safe as first-line treatments for paroxysmal and persistent AF. In some high-risk stroke patients, TTA may be a viable option. It is important to consider patient characteristics when selecting an ablation method for AF.
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Affiliation(s)
- Hee-Jin Kwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Ji Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.K.); (J.H.C.); (H.R.K.); (S.-J.P.); (Y.K.O.); (J.S.K.)
- Correspondence: ; Tel.: +82-2-3410-3419
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24
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Abdulsalam N, Gillis AM, Rzeszut AK, Yong CM, Duvernoy CS, Langan MN, West K, Velagapudi P, Killic S, O'Leary EL. Gender Differences in the Pursuit of Cardiac Electrophysiology Training in North America. J Am Coll Cardiol 2021; 78:898-909. [PMID: 34446162 DOI: 10.1016/j.jacc.2021.06.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the increase in the number of female physicians across most specialties within cardiology, <10% of clinical cardiac electrophysiology (EP) fellows are women. OBJECTIVES This study sought to determine the factors that influence fellows-in-training (FITs) to pursue EP as a career choice and whether this differs by gender. METHODS The authors conducted an online multiple-choice survey through the American College of Cardiology to assess the decision factors that influence FITs in the United States and Canada to pursue cardiovascular subspecialties. RESULTS A total of 933 (30.5%) FITs completed the survey; 129 anticipated specializing in EP, 259 in interventional cardiology (IC), and 545 in a different field or were unsure. A total of 1 in 7 (14%) FITs indicated an interest in EP. Of this group, more men chose EP than women (84% vs 16%; P < 0.001). The most important factor that influenced FITs to pursue EP was a strong interest in the field. Women were more likely to be influenced by having a female role model (P = 0.001) compared with men. After excluding FITs interested in IC, women who deselected EP were more likely than men to be influenced by greater interest in another field (P = 0.004), radiation concerns (P = 0.001), lack of female role models (P = 0.001), a perceived "old boys' club" culture (P = 0.001) and discrimination/harassment concerns (P = 0.001). CONCLUSIONS Women are more likely than men to be negatively influenced by many factors when it comes to pursuing EP as a career choice. Addressing those factors will help decrease the gender disparity in the field.
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Affiliation(s)
- Nashwa Abdulsalam
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA; Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Anne M Gillis
- Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Anne K Rzeszut
- Market Intelligence, American College of Cardiology, Washington, DC, USA
| | - Celina M Yong
- VA Palo Alto Medical Center, Palo Alto, California, USA; Department of Medicine, Stanford University and Stanford Cardiovascular Institute, Stanford, California, USA
| | - Claire S Duvernoy
- VA Ann Arbor Healthcare System/University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan, USA
| | - Marie-Noelle Langan
- Division of Cardiology, Mt. Sinai School of Medicine, New York, New York, USA
| | - Kristin West
- Member Strategy, American College of Cardiology, Washington, DC, USA
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sena Killic
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Edward L O'Leary
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
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25
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Kanitsoraphan C, Techorueangwiwat C, Rattanawong P, Kewcharoen J, Ayinapudi K, Bunch TJ, Groh C, Navaravong L. Zero fluoroscopy approach versus fluoroscopy approach for cardiac arrhythmia ablations: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021; 32:2761-2776. [PMID: 34427955 DOI: 10.1111/jce.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation for cardiac arrhythmias has traditionally been guided by fluoroscopy. Fluoroscopy exposes the patient, operator, and staff to ionizing radiation which has no safe dose void of stochastic and deterministic biologic risks. Zero fluoroscopy (ZF) approaches for catheter ablation have been advocated to eliminate these risks. We conducted a meta-analysis comparing acute procedure success, recurrence-free survival, complications, and procedure times between the approaches. METHODS We conducted a literature search from inception through December 2020 in the databases of EMBASE and MEDLINE. We included randomized controlled trials and cohorts that compared the outcomes of interest in ZF and conventional/low fluoroscopy (CF/LF) approaches. The outcomes sought were acute procedure success, recurrence-free survival, complications, and procedure times. Effect estimates were combined, using the random-effects, generic inverse variance method of DerSimonian and Laird. RESULTS Sixteen studies from 2013 to 2020, including 6052 patients (2219 ZF, 3833 CF/LF) were included. There were no significant differences in acute procedure success rate (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.75-1.59), recurrence-free survival (OR: 1.08, 95% CI: 0.78-1.49), periprocedural complication rate (OR: 0.72, 95% CI: 0.45-1.16), or total procedure time (weighted mean difference 2.32 min, 95% CI: -2.85-7.50) between ZF and CF/LF approaches, respectively. Overall, only 1.26% of patients crossed over from ZF to CF/LF arm. CONCLUSIONS Periprocedural and postprocedural outcomes with a ZF approach compared favorably with traditional fluoroscopic guidance without increasing procedural times. As comfort with ZF grows, coupled with evolving mapping technologies, this method has potential to become the standard approach for catheter ablation.
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Affiliation(s)
- Chanavuth Kanitsoraphan
- Internal Medicine Residency Program, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Chol Techorueangwiwat
- Internal Medicine Residency Program, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | | | - Jakrin Kewcharoen
- Internal Medicine Residency Program, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Karnika Ayinapudi
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher Groh
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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26
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Varley AL, Kreidieh O, Godfrey BE, Whitmire C, Thorington S, D'Souza B, Kang S, Hebsur S, Ravindran BK, Zishiri E, Gidney B, Sellers MB, Singh D, Salam T, Metzl M, Ro A, Nazari J, Fisher WG, Costea A, Magnano A, Oza S, Morales G, Rajendra A, Silverstein J, Zei PC, Osorio J. A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives. J Interv Card Electrophysiol 2021; 62:487-494. [PMID: 34212280 PMCID: PMC8249214 DOI: 10.1007/s10840-021-01031-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
Purpose Catheter ablation has become a mainstay therapy for atrial fibrillation (AF) with rapid innovation over the past decade. Variability in ablation techniques may impact efficiency, safety, and efficacy; and the ideal strategy is unknown. Real-world evidence assessing the impact of procedural variations across multiple operators may provide insight into these questions. The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that will enroll patients at high volume centers, including academic institutions and private practices, with operators performing ablations primarily with low fluoroscopy when possible. The study will also evaluate the contribution of advent in technologies and workflows to real-world clinical outcomes. Methods Patients presenting at participating centers are screened for enrollment. Data are collected at the time of procedure, 10–12 weeks, and 12 months post procedure and include patient and detailed procedural characteristics, with short and long-term outcomes. Arrhythmia recurrences are monitored through standard of care practice which includes continuous rhythm monitoring at 6 and 12 months, event monitors as needed for routine care or symptoms suggestive of recurrence, EKG performed at every visit, and interrogation of implanted device or ILR when applicable. Results Enrollment began in January 2018 with a single site. Additional sites began enrollment in October 2019. Through May 2021, 1,243 patients underwent 1,269 procedures at 13 institutions. Our goal is to enroll 4000 patients. Discussion Real-AF’s multiple data sources and detailed procedural information, emphasis on high volume operators, inclusion of low fluoroscopy operators, and use of rigorous standardized follow-up methodology allow systematic documentation of clinical outcomes associated with changes in ablation workflow and technologies over time. Timely data sharing may enable real-time quality improvements in patient care and delivery. Trial registration Clinicaltrials.gov: NCT04088071 (registration date: September 12, 2019) Supplementary Information The online version contains supplementary material available at 10.1007/s10840-021-01031-w.
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Affiliation(s)
- Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA.
- Birmingham VA Health System, AL, Birmingham, USA.
| | - Omar Kreidieh
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Brigham E Godfrey
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Carolyn Whitmire
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Susan Thorington
- Grandview Medical Group Research, Grandview Medical Center, AL, Birmingham, USA
| | - Benjamin D'Souza
- Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, PA, Philadelphia, USA
| | | | | | | | | | - Brett Gidney
- Santa Barbara Cottage Hospital, CA, Santa Barbara, USA
| | | | - David Singh
- Center for Heart Rhythm Disorders, The Queen's Medical Center, HI, Honolulu, USA
| | - Tariq Salam
- PulseHeart Institute, Multicare Health System, WA, Tacoma, USA
| | - Mark Metzl
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Alex Ro
- NorthShore University HealthSystem, IL, Evanston, USA
| | - Jose Nazari
- NorthShore University HealthSystem, IL, Evanston, USA
| | | | - Alexandru Costea
- Division of Cardiovascular Health and Disease, University of Cincinnati, OH, Cincinnati, USA
| | - Anthony Magnano
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Saumil Oza
- Department of Cardiology, Ascension St. Vincent's Health System, FL, Jacksonville, USA
| | - Gustavo Morales
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
| | | | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, MA, Boston, USA
| | - Jose Osorio
- Heart Rhythm Clinical and Research Solutions, LLC, AL, Birmingham, USA
- Arrhythmia Institute at Grandview Medical Center, AL, Birmingham, USA
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27
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Chiang LLW, Li C, Hong KL, Hui WS, Beh SY, Gong M, Liu T, Li G, Xia Y, Ho J, Roever L, Duong S, Huang G, Tse G, Baranchuk A, Glover BM. The use of minimal fluoroscopy for cardiac electrophysiology procedures: A meta-analysis and review of the literature. Clin Cardiol 2021; 44:814-823. [PMID: 33998690 PMCID: PMC8207968 DOI: 10.1002/clc.23609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/13/2021] [Accepted: 03/31/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Conventional catheter ablation involves prolonged exposure to ionizing radiation, potentially leading to detrimental health effects. Minimal fluoroscopy (MF) represents a safer alternative, which should be explored. Data on the safety and efficacy of this technique are limited. HYPOTHESIS Our hypothesis is that MF is of equal efficacy and safety to conventional catheter ablation with the use of fluoroscopy by performing a meta-analysis of both randomized controlled trials (RCTs) and real-world registry studies. METHODS Pubmed and Embase were searched from their inception to July 2020 for RCTs, cohort and observational studies that assessed the outcomes of catheter ablation using a MF technique versus the conventional approach. RESULTS Fifteen studies involving 3795 patients were included in this meta-analysis. There was a significant reduction in fluoroscopy and procedural time with no difference in acute success (odds ratio [OR]:0.74, 95% CI: 0.50-1.10, p = .14), long-term success (OR:0.92, 95% CI: 0.65-1.31, p = .38), arrhythmia recurrence (OR:1.24, 95% CI: 0.75-2.06, p = .97) or rate of complications. (OR:0.83, 95% CI: 0.46-1.48, p = .65). Additionally sub-group analysis for those undergoing catheter ablation for atrial fibrillation (AF) did not demonstrate a difference in success or complication rates (OR:0.86, 95% CI: 0.30-2.42, p = .77). Multivariate meta-regression did not identify the presence of moderator variables. CONCLUSION This updated meta-analysis demonstrated an overall reduction in procedural and fluoroscopy time for those undergoing a minimal fluoroscopic approach. There was no significant difference in either acute or chronic success rates or complications between a MF approach and conventional approach for the management of all arrhythmias including those undergoing catheter ablation for AF.
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Affiliation(s)
| | - Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Kathryn L Hong
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Winsy Sin Hui
- Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Sze Yi Beh
- Faculty of Medicine, Newcastle University, Newcastle, UK
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jeffery Ho
- Department of Anaesthesia and Intensive care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Leonardo Roever
- Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Minas Gerais, Brazil
| | - Sophia Duong
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Grace Huang
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict M Glover
- Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
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28
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Qian PC, Tedrow UB. Intracardiac Echocardiography to Guide Catheter Ablation of Ventricular Arrhythmias in Ischemic Cardiomyopathy. Card Electrophysiol Clin 2021; 13:285-292. [PMID: 33990267 DOI: 10.1016/j.ccep.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intracardiac echocardiography (ICE) allows intraprocedural assessment of cardiac anatomy and identification of ischemic myocardial scar and is useful for guidance of the ablation catheter and monitoring for complications. In this review, the authors discuss and provide examples of how ICE can be used to obtain additional information to understand arrhythmia mechanisms and facilitate catheter ablation therapy for ventricular arrhythmias arising from ischemic scar substrates.
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Affiliation(s)
- Pierre C Qian
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Usha B Tedrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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29
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Müller-Leisse J, Hillmann HAK, Veltmann C, Duncker D. ["Zero fluoro"-a chance for more women in electrophysiology]. Herzschrittmacherther Elektrophysiol 2021; 32:285-287. [PMID: 33944993 DOI: 10.1007/s00399-021-00767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
Many young women in cardiology are concerned about radiation exposure, and this issue contributes to the low number of female interventional cardiologists. The proportion of women in interventional electrophysiology is particularly low. However, radiation exposure during catheter ablation of arrhythmias can be minimized and even avoided completely using modern 3D mapping systems. The "zero fluoro" approach can improve patients' safety but also motivate more women to become interventional electrophysiologists.
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Affiliation(s)
- Johanna Müller-Leisse
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Henrike Aenne Katrin Hillmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christian Veltmann
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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30
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Kautzner J, Haskova J, Lehar F. Intracardiac Echocardiography to Guide Non-fluoroscopic Electrophysiology Procedures. Card Electrophysiol Clin 2021; 13:399-408. [PMID: 33990278 DOI: 10.1016/j.ccep.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracardiac echocardiography (ICE) is the most practical method for online imaging during electrophysiological procedures. It allows guiding of complex catheter ablation procedures together with electroanatomical mapping systems, either with minimal or with zero fluoroscopy exposure. Besides safe and reproducible transseptal puncture, ICE helps to assess location and contact of the tip of the ablation catheter relative to specific anatomical structures. Another option is visualization of the arrhythmogenic substrate in patients with ventricular arrhythmias. This article describes the clinical utility of ICE in non-fluoroscopic electrophysiology procedures more in detail.
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Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Palacky University Medical School, Olomouc, Czech Republic.
| | - Jana Haskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Frantisek Lehar
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Internal Medicine 1-Cardioangiology, St Anne's University Hospital, Brno, Czech Republic
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31
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Restrepo AJ, Dickfeld TM. Image Integration Using Intracardiac Echography and Three-dimensional Reconstruction for Mapping and Ablation of Atrial and Ventricular Arrhythmias. Card Electrophysiol Clin 2021; 13:365-380. [PMID: 33990275 DOI: 10.1016/j.ccep.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the basis for image integration of intracardiac echocardiography (ICE) with three-dimensional electroanatomic mapping systems and preprocedural cardiac imaging modalities to enhance anatomic understanding and improve guidance for atrial and ventricular ablation procedures. It discusses the technical aspects of ICE-based integration and the clinical evidence for its use. In addition, it presents the current technical limitations and future directions for this technology. This article also includes figures and videos of clinical representative arrhythmia cases where the use of ICE is key to a safe and successful outcome.
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Affiliation(s)
- Alejandro Jimenez Restrepo
- Section of Cardiology, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
| | - Timm Michael Dickfeld
- Section of Cardiac Electrophysiology, Maryland Arrhythmia and Cardiac Imaging Group (MACIG), University of Maryland School of Medicine, 22 South Greene Street, Room N3W77, Baltimore, MD 21201, USA
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Bergonti M, Dello Russo A, Sicuso R, Ribatti V, Compagnucci P, Catto V, Gasperetti A, Zucchetti M, Cellucci S, Vettor G, Dessanai MA, Majocchi B, Moltrasio M, Russo E, Stronati G, Guerra F, Di Biase L, Natale A, Tondo C, Casella M. Long-Term Outcomes of Near-Zero Radiation Ablation of Paroxysmal Supraventricular Tachycardia: A Comparison With Fluoroscopy-Guided Approach. JACC Clin Electrophysiol 2021; 7:1108-1117. [PMID: 33933407 DOI: 10.1016/j.jacep.2021.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications. BACKGROUND Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. METHODS This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications. RESULTS Six-hundred eighteen patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA. CONCLUSIONS CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
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Affiliation(s)
- Marco Bergonti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Rita Sicuso
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Ribatti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Valentina Catto
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Martina Zucchetti
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Selene Cellucci
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulia Vettor
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Antonietta Dessanai
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Department of Cardiovascular Disease, Division of Cardiac Surgery, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
| | - Luigi Di Biase
- Montefiore Medical Center, Albert-Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute (TCAI), St. David's Hospital, Austin, Texas, USA
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy
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Non-fluoroscopic radiofrequency catheter ablation of right- and left-sided ventricular arrhythmias. Adv Cardiol 2021; 16:321-329. [PMID: 33597998 PMCID: PMC7863801 DOI: 10.5114/aic.2020.99268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/13/2020] [Indexed: 01/15/2023]
Abstract
Introduction Radiofrequency catheter ablation (RFCA) is an important method of treatment of ventricular arrhythmias (VAs). In the majority of RFCA, fluoroscopy is used, exposing patients and medical staff to all related side effects. Current experience of non-fluoroscopic (NF)-RFCA in VAs from the left side is limited. Aim Analysis of safety and effectiveness of NF-RFCA of VAs from left- and right-sided cardiac chambers. Material and methods From 2014 to 2018, a group of 128 patients who underwent RFCA of VAs were retrospectively divided into two groups: NF-RFCA and fluoroscopic (F)-RFCA. Patients in each group were then subsequently subdivided into two groups based on VAs localization - left- (LS-Va) and right-sided (RS-Va) VAs. In all patients the CARTO Biosense Webster mapping system was used. Results In group 1 (NF-RFCA n = 88) 66 (75%) patients underwent RFCA of RS-Va and 22 (25%) of LS-Va. Early success was achieved in 89.8% (n = 79) and long term success in 81.8% (n = 72). In group 2 (F-RFCA n = 40) 19 patients (47.5%) had RFCA of RS-Va and 21 (52.5%) patients of LS-Va. Acute procedural success rate was 80% (n = 32) and long-term success 72.5% (n = 29). There were 4 (4.6%) perioperative complications in NF-RFCA and 2 (5%) in F-RFCA. Success rate, procedure time and complications were not significantly different between groups and subgroups in follow-up. Conclusions NF-RFCA in VAs from the right and left cardiac chamber is safe and equally effective as F-RFCA, and it should be implemented as often as possible for protection of patients and electrophysiology staff.
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Cha M, Lee E, Oh S. Zero-fluoroscopy catheter ablation for atrial fibrillation: a transitional period experience. J Arrhythm 2020; 36:1061-1067. [PMID: 33335625 PMCID: PMC7733568 DOI: 10.1002/joa3.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radiofrequency catheter ablation for atrial fibrillation (AF) without using fluoroscopy has been getting popular. In this study, we reported the transition period experience of the zero-fluoroscopy procedure by an experienced operator and shared our zero-fluoroscopy protocol. METHOD A total of consecutive 30 AF ablation cases attempted to be treated without fluoroscopy were investigated. Ten serial cases were grouped as fluoroscopy-guided period, and period 1-3 in chronological order. All zero-fluoroscopy attempted cases were assisted with an intracardiac echocardiography device with a three-dimensional electroanatomical system. RESULTS Complete zero-fluoroscopy procedure was achieved at the 6th case during the transitional period. During the first period, the total procedure time slightly increased in, but afterward, procedure time was continuously decreased, and it became significantly shorter in the third period than the previous fluoroscopy-guided period. Any additional use of fluoroscopy during the transitional period was mainly for transseptal puncture and diagnostic catheter placement into the coronary sinus. Pulmonary vein isolation was achieved in all patients, and there was one case of hemodynamically insignificant moderate amount pericardial effusion. CONCLUSION For an experienced operator, complete zero-fluoroscopy AF ablation might be achieved safely and feasibly within 5-10 cases. Fluoroscopy equipment backup might be useful during the learning period for beginners in the zero-fluoroscopy procedure.
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Affiliation(s)
- Myung‐Jin Cha
- Departments of Internal MedicineSeoul National University HospitalSeoulSouth Korea
| | - Euijae Lee
- Departments of Internal MedicineSeoul National University HospitalSeoulSouth Korea
| | - Seil Oh
- Departments of Internal MedicineSeoul National University HospitalSeoulSouth Korea
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Percell RL, Pike JL, Olmsted RK, Beideck JE, Nunes HL, Johnson KN, Schaffer M, Vachok LB, Sveen SM, Keim EJ, Mohr-Burt SO, Saalfeld RM, Beran CA, Allison TW, Stock JF. The Grand SANS FLUORO (SAy No Series to FLUOROsopy) Study: Examining Fluoroscopy Use in More than 1,000 Ablation Procedures. J Innov Card Rhythm Manag 2020; 11:4224-4232. [PMID: 32983591 PMCID: PMC7510468 DOI: 10.19102/icrm.2020.1100903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The majority of electrophysiologists routinely use fluoroscopy (FLUORO) during ablation procedures for common arrhythmias despite the known complications of radiation exposure and protective lead use. This study assessed the safety of catheter ablation (CA) with FLUORO versus without FLUORO (SANS FLUORO) in patients with the following common arrhythmias: atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, and ventricular tachycardia. A total of 1,258 CA procedures were performed in 816 consecutive patients over a 53-month period (SANS FLUORO CA: 609 patients; FLUORO CA: 209 patients). The secondary outcome was the efficacy of AF ablation in FLUORO versus SANS FLUORO patients. Ultimately, there was no statistically significant difference found concerning the safety of CA in the SANS FLUORO and FLUORO groups in terms of procedure time, vascular complications, tamponade, stroke, or death. FLUORO patients had markedly increased FLUORO time, increased radiation exposure, and increased dose-area product (all p < 0.0001). AF development after SANS FLUORO CA of AF was not different from that after FLUORO CA regardless of the pulmonary vein isolation (PVI) modality used (cryoablation versus radiofrequency) at 24 months (p = 0.21). Additionally, women fared just as well as men after CA ablation for AF. At 36 months, 58% of SANS FLUORO AF device patients were free from AF. As such, SANS FLUORO CA of common arrhythmias appears to be as safe as FLUORO CA but with a markedly reduced level of radiation exposure. Also, SANS FLUORO CA remains as effective as FLUORO CA in the prevention of AF for up to 24 months.
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Affiliation(s)
- Robert L Percell
- SANS FLUORO Institute, Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Casey A Beran
- Abbott Medical, Abbott Laboratories, Abbott Park, IL, USA
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Desai M, Kahaly O, Aslam A, Saifa-Bonsu J, Usmani M, Okabe T, Afzal MR, Houmsse M. Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review. Expert Rev Med Devices 2020; 17:1183-1192. [PMID: 32885677 DOI: 10.1080/17434440.2020.1819789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiac electrophysiology (EP) procedures are frequently performed in patients with cardiac arrhythmias, chronic heart failure, and sudden cardiac death. Most EP procedures involve fluoroscopy, which results in radiation exposure to physicians, patients, and EP lab staff. Accumulated radiation exposure is a known health detriment to patients and physicians. AREA COVERED This review will summarize radiation exposure, dose metrics, complications of radiation exposure, factors affecting radiation exposure, minimizing radiation exposure, zero or near-zero fluoroscopy strategies, and up-to-date research in the area of reducing radiation exposure and best practices. EXPERT COMMENTARY Comprehensive strategies should be implemented in EP laboratories to minimize radiation exposure with standard fluoroscopy. There are routine techniques that can mitigate significant amounts of radiation exposure using standard equipment within the EP lab. The operators need to emphasize that EP practices routinely incorporate non-ionizing radiation sources for cardiac imaging (e.g. magnetic resonance imaging, advanced electroanatomical mapping systems, intracardiac ultrasonography) in addition to other novel technologies to mitigate radiation exposure to patients and physicians.
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Affiliation(s)
| | - Omar Kahaly
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Adil Aslam
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Jonnie Saifa-Bonsu
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Maham Usmani
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
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Saad EB, Slater C, Inácio LAO, Santos GVD, Dias LC, Camanho LEM. Catheter Ablation for Treatment of Atrial Fibrillation and Supraventricular Arrhythmias Without Fluoroscopy Use: Acute Efficacy and Safety. Arq Bras Cardiol 2020; 114:1015-1026. [PMID: 32638895 PMCID: PMC8416121 DOI: 10.36660/abc.20200096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/08/2020] [Indexed: 01/01/2023] Open
Abstract
Fundamento O uso da radiação ionizante em procedimentos médicos está associado a riscos significativos à saúde dos pacientes e da equipe de saúde. Objetivos Avaliar a segurança e a eficácia aguda da ablação por cateter para tratamento da fibrilação atrial (FA) e arritmias supraventriculares (SVTs), utilizando uma abordagem exclusivamente não fluoroscópica, guiada por eco intracardíaco (ICE) e mapeamento 3D. Métodos 95 pts (idade média 60 ± 18 anos, 61% do sexo masculino) programados para ablação de FA (69 pts, 45 FA paroxística e 24 FA persistente) ou SVTs (26 pts – 14 reentrada nodal, 6 Wolf-Parkinson-White [WPW], 5 flutter atrial direito [AD], 1 taquicardia atrial). Nove pacientes (9,5%) tinham marcapasso definitivo ou dispositivos de ressincronização com desfibrilador. Dois sistemas de mapeamento eletroanatômico foram utilizados – CARTO (65%) e NAVx (35%), bem como cateteres de ICE disponíveis – Acunav e ViewFlex. Resultados O isolamento das veias pulmonares (VPs), bem como todos os outros alvos que precisavam de ablação em ambos os átrios, foram alcançados e adequadamente visualizados. Não foram observados derrames pericárdicos, complicações trombóticas ou outras intercorrências nesta série. Punções transseptais difíceis (19 pacientes – 20%) foram realizadas sem fluoroscopia em todos os casos. Não foi utilizada fluoroscopia de backup, e nenhum vestuário de chumbo foi necessário. Avaliações detalhadas dos marcapassos após o procedimento não mostraram nenhum dano aos eletrodos, deslocamentos ou mudanças de limiar. Conclusões Uma estratégia de ablação por cateter sem uso de radiação para FA e outras arritmias atriais é segura e eficaz quando guiada pela utilização adequada do ICE e do mapeamento 3D. Diversos sítios em ambos os átrios podem ser alcançados e adequadamente ablacionados sem a necessidade de fluoroscopia de backup. Não foram observadas complicações. (Arq Bras Cardiol. 2020; 114(6):1015-1026)
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Affiliation(s)
- Eduardo B Saad
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | - Charles Slater
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | | | - Gustavo Vignoli Dos Santos
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | - Lucas Carvalho Dias
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
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Operator learning curve and clinical outcomes of zero fluoroscopy catheter ablation of atrial fibrillation, supraventricular tachycardia, and ventricular arrhythmias. J Interv Card Electrophysiol 2020; 61:165-170. [PMID: 32529314 DOI: 10.1007/s10840-020-00798-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy. METHODS This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve. RESULTS A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p < 0.0001). PVI procedure time was 170 ± 34 min after 60 cases from 235 ± 41 min initially (p 0.001). Six out of 77 (8%) had AF recurrence at 12 months. CONCLUSIONS Zero fluoroscopy ablation for AF, SVT, and PVC can be safely achieved without increasing procedure time. The steepest learning curve occurs over the first 20, 15, and 40 cases for SVT, PVC, and PVI ablation respectively.
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Jan M, Yazici M, Kalinšek TP, Žižek D, Kuhelj D, Pernat A, Lakič N. Fluoroless radiofrequency and cryo-ablation of atrioventricular nodal reentry tachycardia in adults and children: a single-center experience. J Interv Card Electrophysiol 2020; 61:155-163. [PMID: 32519224 DOI: 10.1007/s10840-020-00791-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) and cryo-ablation (CRA) have been traditionally performed with fluoroscopy which exposes patients and medical staff to the potential harmful effects of the X-ray. Therefore, we aimed to assess the feasibility, safety, and effectiveness of RFA and CRA of atrioventricular nodal reentry tachycardia (AVNRT) guided by the three-dimensional (3D) electro-anatomical mapping (EAM) system without the use of fluoroscopy. METHODS We analyzed 168 consecutive patients with AVNRT, 62 of whom were under 19 years of age (128 in RFA (age 34.04 ± 21.0 years) and 40 in CRA (age 39.41 ± 22.8 years)). All procedures were performed completely without the use of the fluoroscopy and with the 3D EAM system. RESULTS The acute success rates (ASR) of the two ablation methods were very high and similar (for RFA 126/128 (98.4%) and for CRA 40/40 (100%); p = 0.43). Total procedural time (TPT) was similar in RFA and CRA groups (75.04 ± 42.31 min and 73.12 ± 30.54 min, respectively; p = 0.79). Recurrence rates (1 (2.5%) and 8 (6.25%); p = 0.35) were similar. There were no complications associated with procedures in either group. In pediatric group, ASR (61/62 (98.38%) and 105/106 (99.05%), respectively; p = 0.69) and TPT (75.16 ± 42.2 min and 74.23 ± 38.3 min, respectively; p = 0.88) were similar to the adult group. High ASR was observed with both ablation methods (for RFA 49/50, 98%, and for CRA 12/12, 100%; p = 0.62] with very high arrhythmia-free survival rates (for RFA 98% and for CRA 100%; p = 0.62). CONCLUSION Based on these results, it can be suggested that fluoroless RFA or CRA guided by the 3D EAM system can be routinely performed in all patients with AVNRT without compromising safety, efficacy, or duration of the procedure.
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Affiliation(s)
- Matevž Jan
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Mehmet Yazici
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - David Žižek
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute for Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Andrej Pernat
- Cardiology Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Nikola Lakič
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Canpolat U, Faggioni M, Della Rocca DG, Chen Q, Ayhan H, Vu AA, Mohanty S, Trivedi C, Gianni C, Bassiouny M, Al-Ahmad A, Burkhardt JD, Sanchez JE, Gallinghouse GJ, Natale A, Horton RP. State of Fluoroless Procedures in Cardiac Electrophysiology Practice. J Innov Card Rhythm Manag 2020; 11:4018-4029. [PMID: 32368376 PMCID: PMC7192123 DOI: 10.19102/icrm.2020.110305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
In the past decade, the use of interventional electrophysiological (EP) procedures for the diagnosis and treatment of cardiac arrhythmias has exponentially increased. These procedures usually require fluoroscopy to guide the advancement and frequent repositioning of intracardiac catheters, resulting in both the patient and the operator being subjected to a considerable degree of radiation exposure. Although shielding options such as lead gowns, glasses, and pull-down shields are useful for protecting the operator, they do not lessen the patient’s level of exposure. Furthermore, the prolonged use of lead gowns can exponentiate the onset of orthopedic problems among operators. Recent advancements in three-dimensional cardiac mapping systems and the use of radiation-free imaging technologies such as magnetic resonance imaging and intracardiac ultrasound allow operators to perform EP procedures with minimal or even no fluoroscopy. In this review, we sought to describe the state of fluoroless procedures in EP practice.
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Affiliation(s)
- Ugur Canpolat
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | | | | | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Huseyin Ayhan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Cardiology, Ankara Yildirim Beyazit, Ankara, Turkey
| | - Andrew A Vu
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Cardiology, California Pacific Medical Center, San Francisco, CA, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Mohammed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve, University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Stanford University, Stanford, CA, USA.,Dell Medical School, University of Texas, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA.,Division of Cardiology, Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX, USA
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41
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Wang G, Chen G, Huang X, Hu J, Yu X. Application of Radiofrequency Ablation in Treatment of Tachyarrhythmia based on CartoUnivu and Carto3 Intelligent System (Preprint). JMIR Med Inform 2020. [DOI: 10.2196/18573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Chen G, Wang Y, Proietti R, Wang X, Ouyang F, Ma CS, Yu RH, Zhao C, Ma K, Qiu J, Liu Q, Wang DW. Zero-fluoroscopy approach for ablation of supraventricular tachycardia using the Ensite NavX system: a multicenter experience. BMC Cardiovasc Disord 2020; 20:48. [PMID: 32013865 PMCID: PMC6996189 DOI: 10.1186/s12872-020-01344-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional electroanatomic mapping systems have demonstrated a significant reduction in radiation exposure during radiofrequency catheter ablation procedures. We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach. METHODS A multicenter prospective non-randomized registry study was performed in seven centers from January 2013 to February 2018. Consecutive patients referred for catheter ablation of supraventricular tachycardia were assigned either to a completely zero-fluoroscopic approach (ZF) or conventional fluoroscopy approach (CF) according to the operator's preference. Patients with atrial tachycardia were excluded. RESULTS Totally, 1020 patients were enrolled in ZF group; 2040 patients ablated by CF approach were selected for controls. There was no significant difference between the zero-fluoroscopy group and conventional fluoroscopy group as to procedure time (60.3 ± 20.3 vs. 59.7 ± 22.6 min, P = 0.90), immediate success rate of procedure (98.8% vs. 99.2%, P = 0.22), arrhythmia recurrence (0.4% vs. 0.5%, P = 0.85), total success rate of procedure (98.4% vs. 98.8%, P = 0.39) or complications (1.1% vs. 1.5%, P = 0.41). Compared with the conventional fluoroscopy approach, the zero-fluoroscopy approach provided similar outcomes without compromising the safety or efficacy of the procedure. CONCLUSION The completely zero-fluoroscopy approach demonstrated safety and efficacy comparable to a conventional fluoroscopy approach for catheter ablation of supraventricular tachycardia, and mitigated radiation exposure to both patients and operators. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03042078; first registered February 3, 2017; retrospectively registered.
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Affiliation(s)
- Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yan Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, via Giustiniani 2, 35121, Padua, Italy
| | - Xunzhang Wang
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Chang Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Rong Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Kezhong Ma
- Department of Cardiology, Xiangyang Central Hospital, Xiangyang, 441021, People's Republic of China
| | - Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qigong Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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43
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Morka A, Śledź J, Deutsch K, Ludwik B, Zagrodzka M, Szydłowski L, Stec S. Feasibility and performance of catheter ablation with zero-fluoroscopy approach for regular supraventricular tachycardia in patients with structural and/or congenital heart disease. Medicine (Baltimore) 2019; 98:e17333. [PMID: 31593082 PMCID: PMC6799864 DOI: 10.1097/md.0000000000017333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ± 13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ± 16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ± 24.6 vs 49.1 ± 23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P = .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.
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Affiliation(s)
- Aleksandra Morka
- Department of Pediatric Cardiosurgery and Cardiosurgical Intensive Care University Children's Hospital in Kraków, Jagiellonian University Medical College, Faculty of Health Sciences, Kraków
| | | | | | - Bartosz Ludwik
- Research and Development Centre in Wroclaw, Department of Cardiology, Regional Specialist Hospital, Wrocław, Poland
| | | | - Lesław Szydłowski
- Medical University of Silesia, Katowice, Poland. Department of Pediatric Cardiology
| | - Sebastian Stec
- El-Medica, EP-Network, Kielce
- MediNice Research and Development Centre, Rzeszów, Poland
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44
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Luani B, Rauwolf T, Genz C, Schmeißer A, Wiemer M, Braun-Dullaeus RC. Intracardiac echocardiography versus fluoroscopy for endovascular and endocardial catheter navigation during cryo-ablation of the slow pathway in AVNRT patients. Cardiovasc Ultrasound 2019; 17:12. [PMID: 31186001 PMCID: PMC6560740 DOI: 10.1186/s12947-019-0162-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. Methods Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. Results Slow pathway ablation or modulation was successful in all patients. Fluoroscopy time and radiation dose in the fluoroscopy group were 11.2 ± 9.0 min and 20.3 ± 16.2Gycm2, whereas no fluoroscopy was used in the opposite group (p < 0.001, respectively). EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). Conclusions Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. Trial registration (German Clinical Trials Register ID: DRKS00011360; Registration Date 14.12.2016) Electronic supplementary material The online version of this article (10.1186/s12947-019-0162-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Blerim Luani
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany.
| | - Thomas Rauwolf
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Conrad Genz
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Alexander Schmeißer
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Hans-Nolte-Str. 1, 32429, Minden, Germany
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Leipzigerstr. 44, 39120, Magdeburg, Germany
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45
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Non-fluoroscopic catheter ablation of arrhythmias with origin at the summit of the left ventricle. J Interv Card Electrophysiol 2019; 56:279-290. [DOI: 10.1007/s10840-019-00522-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
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46
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Sugrue A, Le KY, Dearani P, Asirvatham SJ. Minimizing Radiation-Why Aren't We Down to Zero? J Innov Card Rhythm Manag 2018; 9:3271-3273. [PMID: 32496483 PMCID: PMC7252803 DOI: 10.19102/icrm.2018.090807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Alan Sugrue
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Katherine Y. Le
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Patrick Dearani
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Samuel J. Asirvatham
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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47
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Long-term outcomes after “Zero X-ray” arrhythmia ablation. J Interv Card Electrophysiol 2018; 54:43-48. [DOI: 10.1007/s10840-018-0390-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
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48
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Huang X, Chen Y, Huang Z, He L, Liu S, Deng X, Wang Y, Li R, Xu D, Peng J. Catheter radiofrequency ablation for arrhythmias under the guidance of the Carto 3 three-dimensional mapping system in an operating room without digital subtraction angiography. Medicine (Baltimore) 2018; 97:e11044. [PMID: 29923993 PMCID: PMC6023703 DOI: 10.1097/md.0000000000011044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Several studies have reported the efficacy of a zero-fluoroscopy approach for catheter radiofrequency ablation of arrhythmias in a digital subtraction angiography (DSA) room. However, no reports are available on the ablation of arrhythmias in the absence of DSA in the operating room. To investigate the efficacy and safety of catheter radiofrequency ablation for arrhythmias under the guidance of a Carto 3 three-dimensional (3D) mapping system in an operating room without DSA. Patients were enrolled according to the type of arrhythmia. The Carto 3 mapping system was used to reconstruct heart models and guide the electrophysiologic examination, mapping, and ablation. The total procedure, reconstruction, electrophysiologic examination, and mapping times were recorded. Furthermore, immediate success rates and complications were also recorded. A total of 20 patients were enrolled, including 12 males. The average age was 51.3 ± 17.2 (19-76) years. Nine cases of atrioventricular nodal re-entrant tachycardia, 7 cases of frequent ventricular premature contractions, 3 cases of Wolff-Parkinson-White syndrome, and 1 case of typical atrial flutter were included. All arrhythmias were successfully ablated. The procedure time was 127.0 ± 21.0 (99-177) minutes, the reconstruction time was 6.5 ± 2.9 (3-14) minutes, the electrophysiologic study time was 10.4 ± 3.4 (6-20) minutes, and the mapping time was 11.7 ± 8.3 (3-36) minutes. No complications occurred. Radiofrequency ablation of arrhythmias without DSA is effective and feasible under the guidance of the Carto 3 mapping system. However, the electrophysiology physician must have sufficient experience, and related emergency measures must be present to ensure safety.
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Affiliation(s)
| | - Yanjia Chen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou
| | | | | | | | | | - Yongsheng Wang
- The Second People's Hospital of Jiedong District, Jieyang
| | - Rucheng Li
- Guangning County People's Hospital, Zhaoqing, Guangdong Province, China
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Bansal N, Kobayashi D, Karpawich PP. Pulmonary damage following right ventricular outflow tachycardia ablation in a child: When electroanatomical mapping isn't good enough. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:561-565. [PMID: 29127709 DOI: 10.1111/pace.13236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/14/2017] [Accepted: 10/29/2017] [Indexed: 11/27/2022]
Abstract
A 14-year-old female was referred for severe pulmonary valve insufficiency after undergoing radiofrequency ablation for a right ventricular outflow tract tachycardia that originated in the proximal pulmonary artery at 10 years of age. Clinical records indicated that ablation was guided solely by electrograms and electroanatomical mapping. Due to myocardial tissue extensions, mapping failed to identify the level of the pulmonary valve annulus, which resulted in delivery of energy on the valve proper and into the pulmonary artery. She developed severe pulmonary valve insufficiency and moderate proximal pulmonary artery stenosis necessitating intravascular stent placement 4 years later with an associated transcatheter valve. Although the nonfluoroscopic approach during ablation has gained wide acceptance for use in children, this report highlights the benefits of adjunctive imaging to identify the precise location of the pulmonary valve when ablation therapy is contemplated in the right ventricle outflow tract.
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Affiliation(s)
- Neha Bansal
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Peter P Karpawich
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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50
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Lahiri A, Srinath SC, Chase D, Roshan J. Zero fluoroscopy radiofrequency ablation for Typical Atrioventricular Nodal Reentrant Tachycardia (AVNRT). Indian Pacing Electrophysiol J 2017; 17:180-182. [PMID: 29231822 PMCID: PMC5784602 DOI: 10.1016/j.ipej.2017.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anandaroop Lahiri
- Department of Cardiac Electrophysiology and Pacing, Christian Medical College and Hospital, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
| | - Sirish Chandra Srinath
- Department of Cardiac Electrophysiology and Pacing, Christian Medical College and Hospital, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
| | - David Chase
- Department of Cardiac Electrophysiology and Pacing, Christian Medical College and Hospital, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
| | - John Roshan
- Department of Cardiac Electrophysiology and Pacing, Christian Medical College and Hospital, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
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