December 22, 2015Journal of Innovations in Cardiac Rhythm ManagementOpen Access

Zero-fluoroscopy Intracardiac Echocardiography-guided Ablation of Atrial Fibrillation Using a Single-catheter Technique

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Why the study?

Is a zero-fluoroscopy, single-catheter approach using intracardiac echocardiography guidance feasible and safe for atrial fibrillation ablation?

Structured PICO

Is a zero-fluoroscopy, single-catheter approach using intracardiac echocardiography guidance feasible and safe for atrial fibrillation ablation?

Population

14 patients undergoing radiofrequency ablation of atrial fibrillation

Intervention

Zero-fluoroscopy radiofrequency ablation using intracardiac echocardiography (ICE) guidance, a decapolar coronary sinus catheter, and a single force-sensing ablation catheter in the left atrium

Outcome

Procedural complications and feasibility of zero-fluoroscopysafety

A zero-fluoroscopy, single-catheter approach using ICE guidance for AF ablation appears feasible and safe, potentially reducing radiation exposure and procedural costs.

Limitations

Small sample size (14 patients)
Requires familiarity with ICE
May not be suitable for patients with intracardiac pacing or defibrillator leads
Requires availability of ICE console

Implication

Supports feasibility of zero-fluoroscopy ICE-guided AF ablation; hypothesis-generating and requires prospective trials before practice change.

Abstract

Advanced electroanatomic mapping and contact force-sensing catheters have improved outcomes, increased efficiency, and significantly reduced the need for fluoroscopy during radiofrequency ablation of atrial fibrillation (AF). However, fluoroscopic guidance is still routinely used for the procedure, posing a long-term risk to the patient, the operator, and laboratory staff. Furthermore, rapid high-density mapping has diminished the need for a second multipolar or circular left atrial catheter to demonstrate electrical isolation of pulmonary veins. We describe a novel approach to AF ablation using only intracardiac echo guidance, a decapolar coronary sinus catheter, and a single ablation catheter in the left atrium. Mapping is performed using the CARTO-3 system with Confidense module (Biosense Webster, Diamond Bar, CA) to achieve and verify pulmonary vein isolation.