Key result
Novel ICE and 3D mapping workflow enables safe zero-fluoroscopy PVI for atrial fibrillation.
Why the study?
Fluoroscopy exposes patients and staff to radiation, and while zero-fluoroscopy approaches are widely used in simple ablations, fluoroscopy remains widely used in complex procedures like AF ablation, particularly for transseptal puncture.
Case Report (n=2)
No
A completely zero-fluoroscopy workflow leveraging 3D mapping, ICE, and a trackable sheath is feasible for complex atrial fibrillation ablation procedures including transseptal puncture.
Answers are grounded in this paper and cite their sources.
Supports zero-fluoroscopy AF ablation feasibility; hypothesis-generating and requires prospective validation before adoption.
BACKGROUND AND RATIONALE: A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.
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Bertini et al. (2021) conducted a case report in Atrial Fibrillation (n=2). Zero-fluoroscopy catheter ablation using 3D electro-anatomical mapping, intracardiac echocardiography, and a steerable guiding sheath was evaluated on Successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure. A novel workflow combining 3D electro-anatomical mapping, intracardiac echocardiography, and a trackable steerable sheath enabled successful zero-fluoroscopy pulmonary vein isolation in two patients with atrial fibrillation.
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