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Debreceni D, Janosi KF, Turcsan M, Toth D, Bocz B, Simor T, Kupo P. Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial. Front Cardiovasc Med 2023; 10:1244137. [PMID: 37900565 PMCID: PMC10601457 DOI: 10.3389/fcvm.2023.1244137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Catheter ablation is the preferred treatment for typical atrial flutter (AFl), but it can be challenging due to anatomical abnormalities. The use of 3D electroanatomical mapping systems (EAMS) has reduced fluoroscopy exposure during AFl ablation. Intracardiac echocardiography (ICE) has also shown benefits in reducing radiation exposure during AFl ablation. However, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS. Methods In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The first 40 patients underwent standard fluoroscopy + ICE-guided ablation (Standard ICE group), while the other 40 patients underwent zero-fluoroscopy ablation using only ICE (Zero ICE group). Procedure outcomes, including acute success, procedure time, fluoroscopy time, radiation dose, and complications, were compared between the groups. Results The acute success rate was 100% in both groups. Out of the 40 cases, the zero-fluoroscopy strategy was successfully implemented in 39 cases (97.5%) in the Zero ICE group. There were no significant differences in procedure time [55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p = 0.50] and puncture to first ablation time [18 (13.5; 23) min vs. 19 (15; 23.5) min, p = 0.50] between the groups. The Zero ICE group had significantly lower fluoroscopy time [57 (36.3; 90) sec vs. 0 (0; 0) sec, p < 0.001] and dose [3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p < 0.001] compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group [597 (447; 908) sec vs. 430 (260; 750), p = 0.02], but total ablation energy [22,458 (14,836; 31,116) Ws vs. 17,043 (10,533; 29,302) Ws, p = 0.10] did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were similar between the groups. No complications or recurrences were observed during the follow-up period. Conclusion Our study suggests that zero-fluoroscopy CTI ablation guided solely by ICE for AFl is feasible and safe. Further investigation is warranted for broader validation.
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Affiliation(s)
| | | | | | | | | | | | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
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2
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Mladoniczky S, Nagy Z, Földesi C, Som Z, Bálint HO, Környei L, Ruzsa D, Fődi E, Simor T, Kardos A. Case series of catheter-based arrhythmia ablation in 13 pregnant women. Clin Cardiol 2023; 46:942-949. [PMID: 37408170 PMCID: PMC10436797 DOI: 10.1002/clc.24072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Catheter ablation is a rarely used procedure to treat arrhythmias during pregnancy. HYPOTHESIS In the case of maternal arrhythmia during pregnancy, zero-fluoroscopic catheter ablation is preferable to medical treatment. METHODS Between April 2014 and September 2021, we examined the demographic data, procedural parameters, and fetal and maternal outcomes in pregnant women undergoing ablation at the Gottsegen National Cardiovascular Center and University of Pécs Medical School, Heart Institute. RESULTS Fourteen procedures (14 electrophysiological studies [EPS], 13 ablations) performed on 13 pregnant women (age 30.3 ± 5.2 years, primipara n = 6) were studied. During EPS, 12 patients had inducible arrhythmias. Atrial tachycardia was confirmed in three, atrioventricular re-entry tachycardia via manifest accessory pathway (AP) in three, and via concealed AP in one case. Atrioventricular nodal re-entry tachycardia was confirmed in three and sustained monomorphic ventricular tachycardia in two cases. Eleven radiofrequency ablation (84.6%) and two cryoablation (15.4%) were performed. The electroanatomical mapping system was used in all cases. Transseptal puncture was performed in two cases (15.4%) due to left lateral APs. The mean procedure time was 76.0±33.0 minutes. All procedures were performed without fluoroscopy. No complications occurred. During the follow-up, arrhythmia-free survival was achieved in all cases, but in two patients, we used antiarrhythmic drugs (AADs) to achieve it. APGAR score was within the normal range in all cases [median (interquartile range), 9.0/10.0 (9.0-10.0/9.3-10.0)]. CONCLUSIONS Zero-fluoroscopic catheter ablation was an effective and safe treatment option for our 13 pregnant patients. Catheter ablation may have less side effects on fetal development than the use of AADs during pregnancy.
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Affiliation(s)
- Sára Mladoniczky
- Adult Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
| | - Zsófia Nagy
- Adult Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
| | - Csaba Földesi
- Adult Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
| | - Zoltán Som
- Adult Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
| | - Hajnalka O. Bálint
- Adult Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
| | - László Környei
- Pediatric Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
| | - Diána Ruzsa
- University of Pécs Medical SchoolHeart InstitutePécsHungary
| | - Eszter Fődi
- University of Pécs Medical SchoolHeart InstitutePécsHungary
| | - Tamás Simor
- University of Pécs Medical SchoolHeart InstitutePécsHungary
| | - Attila Kardos
- Adult Cardiology DepartmentGottsegen National Cardiovascular CenterBudapestHungary
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3
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Piros K, Perge P, Salló Z, Herczeg S, Nagy VK, Osztheimer I, Merkely B, Gellér L, Szegedi N. Zero fluoroscopy ablation for atrioventricular nodal reentrant tachycardia and typical atrial flutter is equally safe and effective with EnSite NavX, Carto3, and Rhythmia mapping systems. Front Cardiovasc Med 2023; 10:1185187. [PMID: 37560116 PMCID: PMC10407085 DOI: 10.3389/fcvm.2023.1185187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Our purpose was to compare the procedural characteristics, success rate, and complication rate of the conventional fluoroscopic (CF) and the zero-fluoroscopic (ZF) approach in patients undergoing catheter ablation of AVNRT or typical atrial flutter (Aflu). METHODS 186 consecutive patients with an indication for AVNRT or Aflu ablation were enrolled. Based on the operator's preference, the patients were assigned to either CF or ZF group. In the ZF group EnSite NavX, Carto3, or Rhythmia EAMS were used for catheter guidance. RESULTS The median age was 56 (IQR = 42-68) years, 144 patients had AVNRT, and 42 had Aflu ablation. CF approach was chosen in 123 cases, while ZF in 63 cases. ZF approach was used more often in case of AVNRT patients [56 (39%) vs. 7 (17%), p = 0.006] and in the case of female patients [43 (68%) vs. 20 (32%), p = 0.008]. Acute procedural success was obtained in all cases. There was no difference in the complication rate (1 vs. 1, p > 0.99) between the two groups. No difference was found regarding the procedure time between the CF and ZF groups [CF: 55 (46-60) min, ZF 60 (47-65) min; p = 0.487] or in the procedure time for the different EAMS [EnSite NavX: 58 (50-63) min, Carto3: 60 (44.5-66.3) min, Rhythmia: 55 (35-69) min; p = 0.887]. A similar success rate was seen at the 3-month follow-up in the two groups [41 (100%) vs. 96 (97%); p = 0.55]. DISCUSSION The ZF approach demonstrated non-inferiority in safety and efficacy compared with CF for the AVNRT and Aflu ablations.
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4
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Debreceni D, Janosi K, Bocz B, Turcsan M, Lukacs R, Simor T, Antolič B, Vamos M, Komocsi A, Kupo P. Zero fluoroscopy catheter ablation for atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1178783. [PMID: 37396578 PMCID: PMC10313423 DOI: 10.3389/fcvm.2023.1178783] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Catheter ablation for atrial fibrillation (AF) is the most frequently performed cardiac ablation procedure worldwide. The majority of ablations can now be performed safely with minimal radiation exposure or even without the use of fluoroscopy, thanks to advances in 3-dimensional electroanatomical mapping systems and/or intracardiac echocardiography. The aim of this study was to conduct a meta-analysis to compare the effectiveness of zero fluoroscopy (ZF) versus non-zero fluoroscopy (NZF) strategies for AF ablation procedures. Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of ZF vs. NZF approaches in patients undergoing catheter ablation for AF. We used a random-effects model to derive the mean difference (MD) and risk ratios (RR) with a 95% confidence interval (CI). Results Our meta-analysis included seven studies comprising 1,593 patients. The ZF approach was found to be feasible in 95.1% of patients. Compared to the NZF approach, the ZF approach significantly reduced procedure time [mean difference (MD): -9.11 min (95% CI: -12.93 to -5.30 min; p < 0.01)], fluoroscopy time [MD: -5.21 min (95% CI: -5.51 to -4.91 min; p < 0.01)], and fluoroscopy dose [MD: -3.96 mGy (95% CI: -4.27 to -3.64; p < 0.01)]. However, there was no significant difference between the two groups in terms of total ablation time [MD: -104.26 s (95% CI: -183.37 to -25.14; p = 0.12)]. Furthermore, there was no significant difference in the acute [risk ratio (RR): 1.01, 95% CI: 1.00-1.02; p = 0.72] and long-term success rates (RR: 0.96, 95% CI: 0.90-1.03; p = 0.56) between the ZF and NZF methods. The complication rate was 2.76% in the entire study population and did not differ between the groups (RR: 0.94, 95% CI: 0.41-2.15; p = 0.89). Conclusion The ZF approach is a feasible method for AF ablation procedures. It significantly reduces procedure time and radiation exposure without compromising the acute and long-term success rates or complication rates.
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Affiliation(s)
| | - Kristof Janosi
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Botond Bocz
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Marton Turcsan
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Reka Lukacs
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Simor
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Bor Antolič
- Department of Cardiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andras Komocsi
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
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Miranda-Arboleda AF, Burak C, Abdollah H, Baranchuk A, Aksu T, Enriquez A. Non-fluoroscopic Cardioneuroablation for Deglutition-induced Syncope: Not a Bitter Pill to Swallow. J Innov Card Rhythm Manag 2023; 14:5385-5388. [PMID: 36998418 PMCID: PMC10044778 DOI: 10.19102/icrm.2023.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 04/01/2023] Open
Abstract
Swallowing is an uncommon trigger of reflex situational syncope. We discuss the case of a 61-year-old woman who presented without a prior cardiac history complaining of 15 years of dizzy spells and hot facial flushing provoked by the swallowing of solid foods.
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Affiliation(s)
- Andrés F. Miranda-Arboleda
- Queen’s University, Kingston Health Science Centre, Kingston, Ontario, Canada
- Address correspondence to: Andrés F. Miranda-Arboleda, MD, Queen’s University, Kingston Health Science Centre, 76 Stuart Street, Kingston, ON K7L 2V7, Canada.
| | - Cengiz Burak
- Queen’s University, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Queen’s University, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Queen’s University, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University, Faculty of Medicine, Istanbul, Turkey
| | - Andres Enriquez
- Queen’s University, Kingston Health Science Centre, Kingston, Ontario, Canada
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6
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Ramos-Maqueda J, Melero-Polo J, Montilla-Padilla I, Ruiz-Arroyo JR, Cabrera-Ramos M. Feasibility and safety of zero-fluoroscopy left bundle branch pacing: An initial experience. J Cardiovasc Electrophysiol 2023; 34:429-436. [PMID: 36448425 PMCID: PMC10107534 DOI: 10.1111/jce.15765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Left bundle branch pacing (LBBP) has emerged in recent years as a new pacing modality, providing patients with a narrower paced QRS than conventional pacing and stable pacing parameters. At the same time, there is a growing concern about the use of fluoroscopy in pacemaker implantations, given its harmful effects on both patients and operators. However, there are no prior experiences of zero-fluoroscopy in LBBP procedure. METHODS We conducted an observational prospective study recruiting consecutive patients that underwent zero-fluoroscopy LBBP pacemaker implantation. A 6-month follow-up visit was programmed for every patient. The main goal of our study was to assess the efficacy, feasibility, and safety of the procedure. RESULTS From January 2021 to February 2022, we included 10 patients, 8 males. The average age was 63 ± 4 years. The procedure was successful in all patients. We observed a significant reduction in paced QRS width compared with basal QRS width (149 ± 31.9 vs. 116 ± 15.6 ms, p = .02). All device parameters remained stable at 6-month follow-up: no significant differences in mean impedance (700.5 ± 136.4 vs. 494 ± 72.7 Ohm, p = .09), capture threshold (0.67 ± 0.2 vs. 0.83 ± 0.2 V @ 0.4 ms, p = .27) or endocardial V-wave amplitude (10.6 ± 5.2 vs. 13.9 ± 6.3 mV, p = .19). No complications were reported in any case. CONCLUSION Zero-fluoroscopy LBBP is feasible and safe, and it may be considered in cases where radiation exposure is contraindicated or especially undesirable. Future randomized clinical trials are needed for the widespread use of this new technique.
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Affiliation(s)
- Javier Ramos-Maqueda
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - Jorge Melero-Polo
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - Isabel Montilla-Padilla
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Department of Cardiology, University Hospital Clinico Lozano Blesa, Zaragoza, Spain.,Arrhytmias Unit, Instituto Investigación Sanitaria Aragón, Aragon, Spain
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7
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Rahman M, Moore JP, Papagiannis J, Smith G, Anderson C, Shannon KM, Razminia M, Tuzcu V, McNinch NL, Shauver LM, Clark JM. Utilising electroanatomic mapping during ablation in patients with CHD to reduce radiation exposure. Cardiol Young 2022; 32:1580-4. [PMID: 34789361 DOI: 10.1017/S1047951121004558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with CHD can be exposed to high levels of cumulative ionising radiation. Utilisation of electroanatomic mapping during catheter ablation leads to reduced radiation exposure in the general population but has not been well studied in patients with CHD. This study evaluated the radiation sparing benefit of using three-dimensional mapping in patients with CHD. METHODS Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy multi-institutional registry. Patients with CHD were selected. Those with previous ablations, concurrent diagnostic or interventional catheterisation and unknown arrhythmogenic foci were excluded. The control cohort was matched for operating physician, arrhythmia mechanism, arrhythmia location, weight and age. The procedure time, rate of fluoroscopy use, fluoroscopy time, procedural success, complications, and distribution of procedures per year were compared between the two groups. RESULTS Fifty-six patients with congenital heart disease and 56 matched patients without CHD were included. The mean total procedure time was significantly higher in patients with CHD (212.6 versus 169.5 minutes, p = 0.003). Their median total fluoroscopy time was 4.4 minutes (compared to 1.8 minutes), and their rate of fluoroscopy use was 23% (compared to 13%). The acute success and minor complication rates were similar and no major complications occurred. CONCLUSIONS With the use of electroanatomic mapping during catheter ablation, fluoroscopy use can be reduced in patients with CHD. The majority of patients with CHD received zero fluoroscopy.
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Pentimalli F, Cornara S, Astuti M, Bacino L, Somaschini A, Mazzucchi P, Buscaglia E, Cordone S, Ghione M, Errigo D, Bellone P. A reliable fossa ovalis impedance mapping for safer transseptal puncture: A new vision beyond voltage. J Cardiovasc Electrophysiol 2021; 32:3270-3274. [PMID: 34664750 DOI: 10.1111/jce.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/09/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Transseptal puncture (TSP) is widely used in clinical practice but is negatively affected by a nonneglectable rate of complications and X-ray exposure. To address these problems, we investigated whether or not impedance mapping could correctly identify fossa ovalis (FO) and safely guide TSP. METHODS AND RESULTS Electroanatomic mapping was performed with CARTO 3 system version 7 and a ThermoCool® SmartTouch® mapping catheter was employed. In each patient, an impedance map and a bipolar voltage map of the whole interatrial septum were collected, acquiring at least 150 points with a contact force ≥2 g and using the pattern matching filter. Thirty-five patients were enrolled. A low impedance area was clearly identified in 34 of them. In 30 patients (88%), the FO was located in the low impedance area. The map was obtained in sinus rhythm in 17 cases (50%); in 15 of these (88%), the TSP site, the patent foramen ovale, or the FO tenting area fell inside the low impedance area. The same numbers were observed when mapping during atrial fibrillation. CONCLUSION To the best of our knowledge, this is the first study that provides the reliability and reproducibility of impedance mapping in identifying FO, an affordable and feasible tool that could be potentially introduced into clinical practice.
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Affiliation(s)
- Francesco Pentimalli
- S.S. di elettrofisiologia cardiaca, S.C. di cardiologia, Ospedale San Paolo, Savona, Italy.,S.C. di cardiologia, Ospedale San Paolo, Savona, Italy
| | - Stefano Cornara
- S.S. di elettrofisiologia cardiaca, S.C. di cardiologia, Ospedale San Paolo, Savona, Italy.,S.C. di cardiologia, Ospedale San Paolo, Savona, Italy
| | - Matteo Astuti
- S.S. di elettrofisiologia cardiaca, S.C. di cardiologia, Ospedale San Paolo, Savona, Italy.,S.C. di cardiologia, Ospedale San Paolo, Savona, Italy
| | - Luca Bacino
- S.S. di elettrofisiologia cardiaca, S.C. di cardiologia, Ospedale San Paolo, Savona, Italy.,S.C. di cardiologia, Ospedale San Paolo, Savona, Italy
| | | | - Paolo Mazzucchi
- Biosense Webster, Johnson & Johnson Medical S.p.A., Pomezia, Italy
| | | | | | - Matteo Ghione
- S.C. di cardiologia, Ospedale San Paolo, Savona, Italy
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9
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Gras M, Garcia R, Waldmann V, Bergère V, Duncker D, De Potter T, Fiedler L, Moscoso Costa F, Antolič B, Kosiuk J. Independent factors of low radiation dose during atrial fibrillation ablation with cryoballoon or radiofrequency: Results from the "Go for zero fluoroscopy" registry. Pacing Clin Electrophysiol 2021; 44:1853-1860. [PMID: 34564877 DOI: 10.1111/pace.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
AIMS Atrial fibrillation (AF) catheter ablation is a common procedure requiring in most cases the use of fluoroscopy. We aimed to evaluate the factors associated with a lower dose of fluoroscopy used during AF ablation with cryoballoon or radiofrequency. METHODS In this prospective European registry, centers were requested to provide procedural characteristics of consecutive AF ablation cases. Lower doses of fluoroscopy were defined as those with dose-area-product (DAP) under the median dose used in the radiofrequency and the cryoballoon ablation groups. RESULTS A total of 638 AF ablation procedures were collected (n = 492 for radiofrequency and n = 146 for cryoballoon ablation groups) in 25 centers. The median [IQR] DAP were 926 [349;2092] and 1516 [418;3408] cGy*cm2 in the radiofrequency and cryoballoon groups, respectively. Main factors associated with lower DAP in cryoballoon ablation group were electrophysiology dedicated laboratory (OR 6.04, 95%CI 1.16-31.54; P = .03) and frequent dosimetry report (OR 21.39, 95%CI 5.43-98.54; P = .03). Main factors associated with lower DAP in the radiofrequency ablation group were the use of a chest dosimeter (OR 12.57, 95% CI 2.88-54.90; P = .01), biplane X-ray equipment (OR 3.12, 95%CI 1.89-5.16; P < .01), university hospital (OR 2.10, 95%CI 1.35-3.25; P = .01), electrophysiology dedicated laboratory (OR 2.45, 95%CI 1.48-4.05; P < .01) and use of contact force enabled catheter (OR 22.60, 95%CI 6.82-74.88; P < .01). CONCLUSION This real-life study of fluoroscopy use during AF ablation provides new data about current practices across European countries. Technological advances and quality of the fluoroscopic environment were the main factors associated with lower radiation dose during AF ablation.
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Affiliation(s)
- Matthieu Gras
- Cardiology department, University hospital of Poitiers, Poitiers, France
| | - Rodrigue Garcia
- Cardiology department, University hospital of Poitiers, Poitiers, France.,Faculté de Médecine et Pharmacie, Poitiers, France
| | - Victor Waldmann
- Cardiology department, European Hospital Georges Pompidou, Paris, France
| | - Vincent Bergère
- Cardiology department, University hospital of Poitiers, Poitiers, France
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | | | - Lukas Fiedler
- Department of Internal Medicine II, General Hospital Wiener Neustadt, Wiener Neustadt, Austria.,Department of Cardiology, Paracelsus Medical University of Salzburg, Clinic of Internal Medicine II, Salzburg, Austria
| | | | - Bor Antolič
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jedrzej Kosiuk
- Rhythmology Department, Helios Clinic Koethen, Koethen, Germany
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Antolič B, Kajdič N, Vrbajnščak M, Jan M, Žižek D. Integrated 3D intracardiac ultrasound imaging with detailed pulmonary vein delineation guided fluoroless ablation of atrial fibrillation. Pacing Clin Electrophysiol 2021; 44:1487-1496. [PMID: 34245035 DOI: 10.1111/pace.14315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/04/2021] [Accepted: 07/04/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) has become an all-round tool for ablation of atrial fibrillation (AF) since it plays an important role in all procedural steps. The key upgrade to the usefulness of ICE is its integration into three-dimensional (3D) electroanatomic mapping (EAM) system (ICE/EAM automatic integration system). The aim of this single-center retrospective study was to evaluate feasibility, safety and acute efficacy of ICE/EAM automatic integration system guided fluoroless ablation of AF. METHODS The study included patients with symptomatic paroxysmal or persistent AF undergoing first pulmonary vein isolation (PVI) radiofrequency (RF) catheter ablation (RFCA) from September 2017 to August 2020. All procedures were performed without the use of fluoroscopy. A detailed 3D virtual anatomy of the left atrium (LA) and structures relevant to AF ablation was constructed from ultrasound contours obtained with ICE probe inside the LA. Pulmonary veins (PVs) and antral regions were additionally mapped with fast anatomical mapping (FAM). PVI was performed with contact force (CF) sensing catheter. Procedural endpoint was successful PVI. RESULTS A total of 98 consecutive patients underwent RFCA (34.7% females, median age 64.4 years, 64.3% paroxysmal AF). Acute PVI was achieved in all patients (100%). Forty-three patients (43.9%) underwent additional ablations for concomitant arrhythmias. Adverse events were detected in four patients (4.1%). The median procedure duration was 130 min (IQR 103.8-151.3). If only PVI was done the median procedure duration was 110.5 (IQR 100.0-133.8) CONCLUSIONS: ICE/EAM automatic integration system guided fluoroless ablation of AF is feasible, safe and acutely effective method for treatment of symptomatic AF.
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Affiliation(s)
- Bor Antolič
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Kajdič
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mojca Vrbajnščak
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matevž Jan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Žižek
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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12
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Giaccardi M, Anselmino M, Del Greco M, Mascia G, Paoletti Perini A, Mascia P, De Ferrari GM, Picano E. Radiation awareness in an Italian multispecialist sample assessed with a web-based survey. Acta Cardiol 2021; 76:307-311. [PMID: 32228163 DOI: 10.1080/00015385.2020.1733303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The awareness of radiation doses and risks, also during interventional cardiology procedures, is essential today in order to apply the risk-benefit assessment and to reinforce the principles of justification and optimisation in clinical practice. METHODS A voluntary survey with 10 questions and multiple-choice answers was run on a popular cardiology website (www.cardiolink.it) independently by a scientific publisher, in order to evaluate the contemporary level of radiation awareness in a multi-speciality sample of physicians in Italy. RESULTS One thousand eight hundred and sixty-one physicians completed the test. The survey showed good results since both prescribers and practitioners (mostly cardiologists) working in Italy are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. CONCLUSION Physicians are largely aware of the cancer and non-cancer risks of medical radiation use, regardless of their subspecialty background. However, there is still broad space for improvement; in the future, the awareness of radiation risk is a prerequisite to create a culture of respect for radiation hazard and a commitment to minimise exposure and maximise protection.
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Affiliation(s)
- Marzia Giaccardi
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Matteo Anselmino
- Department of Medical Sciences, Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | | | - Giuseppe Mascia
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Paoletti Perini
- Department of Internal Medicine, Cardiology and Electrophysiology Unit, Azienda USL Toscana Centro, Florence, Italy
| | - Paola Mascia
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Gaetano Maria De Ferrari
- Department of Medical Sciences, Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
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13
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Karkowski G, Kuniewicz M, Koźluk E, Chyży T, Ząbek A, Dusza M, Lelakowski J. Non-fluoroscopic radiofrequency catheter ablation of right- and left-sided ventricular arrhythmias. Adv Cardiol 2020; 16:321-9. [PMID: 33597998 DOI: 10.5114/aic.2020.99268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Zei PC, Quadros KK, Clopton P, Thosani A, Ferguson J, Brodt C, O'Riordan G, Ramsis M, Mitra R, Baykaner T. Safety and Efficacy of Minimal- versus Zero-fluoroscopy Radiofrequency Catheter Ablation for Atrial Fibrillation: A Multicenter, Prospective Study. J Innov Card Rhythm Manag 2020; 11:4281-4291. [PMID: 33262896 PMCID: PMC7685314 DOI: 10.19102/icrm.2020.111105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023] Open
Abstract
Radiofrequency catheter ablation (CA) is an effective treatment for atrial fibrillation (AF) that traditionally requires fluoroscopic imaging to guide catheter movement and positioning. However, advances in electroanatomic mapping (EAM) technology and intracardiac echocardiography (ICE) have reduced procedural reliance on fluoroscopy. We conducted a prospective registry study of 162 patients enrolled at five centers proficient in high-volume, minimal-fluoroscopy CA between March 2016 and March 2018 for the CA of symptomatic, drug-refractory paroxysmal, or persistent AF that sought to assess the safety and efficacy of minimal- versus zero-fluoroscopy AF CA. We evaluated procedural details, acute procedural outcomes and complications, and one-year follow-up data. All operators used an EAM system (CARTO®; Biosense Webster, Irvine, CA, USA) and ICE. Ultimately, two patients did not pursue CA postenrollment. A total of 104 (66%) patients had paroxysmal AF with a mean ejection fraction of 58% ± 9%. Twenty-six (16.3%) patients were scheduled for repeat ablation. A total of 100 (63%) procedures were performed with zero fluoroscopy. The mean fluoroscopy time in the minimal-fluoroscopy group was 1.7 minutes ± 2.8 minutes. Further, the mean procedure duration was 192 minutes ± 37 minutes in the zero-fluoroscopy group and 201 minutes ± 29 minutes in the minimal-fluoroscopy group (p = 0.96). Pulmonary vein isolation was achieved in 153 patients (100%), with an acute procedural complication rate of 1.8%. One-year follow-up data were available for 152 (95%) patients with a mean follow-up time of 11.3 months ± 1.8 months. A total of 118 (76%) patients remained free from arrhythmia for up to 12 months, with no difference between the minimal- and zero-fluoroscopy cohorts (p = 0.18).
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Affiliation(s)
- Paul C Zei
- Brigham and Women's Hospital, Boston, MA, USA
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Affiliation(s)
- Junaid Bhutto
- Cardiac Arrhythmia Group, Cardiovascular Center of Excellence, HonorHealth, Scottsdale, AZ, USA
| | - Rahul N. Doshi
- Cardiac Arrhythmia Group, Cardiovascular Center of Excellence, HonorHealth, Scottsdale, AZ, USA
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17
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Zhang G, Cheng L, Liang Z, Zhang J, Dong R, Hang F, Wang X, Wang Z, Zhao L, Wang Z, Wu Y. Zero-fluoroscopy transseptal puncture guided by right atrial electroanatomical mapping combined with intracardiac echocardiography: A single-center experience. Clin Cardiol 2020; 43:1009-1016. [PMID: 32506504 PMCID: PMC7462191 DOI: 10.1002/clc.23401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background Right atrial electroanatomical mapping may be combined with SoundStar 3D diagnostic ultrasound catheter (EAM‐ICE) as a zero‐fluoroscopy procedure for radiofrequency catheter ablation (RFCA). We aimed to evaluate the efficiency and safety of zero‐fluoroscopy transseptal puncture guided by EAM‐ICE and fluoroscopy combined with intracardiac echocardiography (F‐ICE) in patients with paroxysmal atrial fibrillation (PAF). Hypothesis Zero‐fluoroscopy transseptal puncture is an effective and safe procedure. Methods This study had a prospective design. A total of 57 patients with PAF were enrolled and assigned to two groups. Twenty‐seven patients were enrolled in the EAM‐ICE group, and 30 patients were enrolled in the F‐ICE group. Results There were no statistically significant differences in baseline patient characteristics between groups. Transseptal puncture was successful in all patients (57/57, 100%). Total procedure time and duration of transseptal puncture were lower in the F‐ICE group (199.4 ± 26.0 minutes vs 150.7 ± 22.1 minutes, P = 0.000; 118.4 ± 19.7 vs 70.5 ± 13.5 minutes, P = 0.000). There was no use of fluoroscopy in the EAM‐ICE group (0 mGy vs 70.5 ± 13.5 mGy); the duration of fluoroscopy in the EAM‐ICE group was negligible (0 minutes vs 5.4 ± 1.9 minutes). No procedural complication occurred in either group. Conclusions EAM‐ICE guided zero‐fluoroscopy transseptal puncture is an effective and safe procedure.
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Affiliation(s)
- Guangping Zhang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Liting Cheng
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Zhuo Liang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Junmeng Zhang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Ruiqing Dong
- Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina
| | - Fei Hang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Xinlu Wang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Ziyu Wang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Lin Zhao
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Zefeng Wang
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
- Department of Lung and Blood Vessel DiseaseBeijing Institute of HeartBeijingChina
| | - Yongquan Wu
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical UniversityBeijingChina
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18
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Huang HD, Serafini N, Rodriguez J, Sharma PS, Krishnan K, Trohman RG. Near-zero Fluoroscopic Approach for Laser Balloon Pulmonary Vein Isolation Ablation: A Case Study. J Innov Card Rhythm Manag 2020; 11:4069-4074. [PMID: 32368382 PMCID: PMC7192128 DOI: 10.19102/icrm.2020.110402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
Fluoroscopy remains a cornerstone imaging modality for catheter placement and positioning in electrophysiology device and ablation procedures. However, efforts are being made to reduce the cumulative exposure to radiation in the patient and physician alike. We present the case of a 59-year-old male patient with hypertension, chronic kidney disease, and paroxysmal atrial fibrillation who underwent successful near-fluoroless laser balloon (LB) pulmonary vein isolation (PVI) ablation. Though this case demonstrates the usage of a novel protocol for near-fluoroless LB ablation that resulted in successful, uncomplicated acute PVI, the feasibility and safety of this technique should be validated in a larger series or prospective comparative study.
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Affiliation(s)
- Henry D Huang
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Nicholas Serafini
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Jason Rodriguez
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Parikshit S Sharma
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Kousik Krishnan
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Trohman
- Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
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Santoro A, Di Clemente F, Baiocchi C, Zacà V, Bianchi C, Bellini C, Falciani F, Valente S, Gaspardone A, Lamberti F. From near-zero to zero fluoroscopy catheter ablation procedures. J Cardiovasc Electrophysiol 2019; 30:2397-2404. [PMID: 31424119 DOI: 10.1111/jce.14121] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
Abstract
AIMS The use of electroanatomical mapping (EAM) systems can reduce radiation exposure (RX) and it can also completely eliminate the use of RX. Radiation exposure related to conventional radiofrequency ablation procedures can have a stochastic and deterministic effect on health. The main aim of this study was to evaluate the safety and feasibility of an entirely nonfluoroscopic approach to catheter ablation (CA) using EAM CARTO3. METHODS In 2011 we started an RX-minimization programme in all procedures using the CARTO system with the deliberate intention to not resort to the aid of RX unless strictly necessary. We divided procedures into two groups (group 1: from 2011 to 2013; group 2: from 2014 to 2017). The only exclusion criteria were the need for transseptal puncture, and nonidiopathic ventricular tachycardia (VT). RESULTS From a total of 525 procedures, we performed CA entirely without RX in 78.5% of cases. From 2011 to 2013, we performed CA without RX in 38.5% of cases; from 2014 to 2017, we performed 96.2% of cases with zero RX. The use of RX was significantly reduced in group 2 (group 2: 1.4 ± 19.6 seconds vs group 1: 556.92 ± 520.76 seconds; P < .001). These differences were irrespective of arrhythmia treatment. There were no differences between the two groups in acute success, complications, or duration of procedures. CONCLUSION CA of supraventricular tachycardia and VT entirely without RX, guided by the CARTO system, is safe, feasible, and effective. After an adequate learning curve, CA can be performed entirely without RX.
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Affiliation(s)
- Amato Santoro
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Claudia Baiocchi
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Valerio Zacà
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Claudio Bianchi
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
| | - Cesare Bellini
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
| | - Francesca Falciani
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Serafina Valente
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Achille Gaspardone
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
| | - Filippo Lamberti
- Department of Medicine, Cardiovascular Section, San Eugenio Hospital, Rome, Italy
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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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