Nonfluoroscopic mapping reduces radiation exposure in ablation of atrial fibrillation

BACKGROUND: Radiofrequency catheter ablation (RFCA) of atrial fibrillation is an effective and definitive treatment. The methods used to guide RFCA have evolved over the years from a purely electrophysiological approach, in which anatomical lesions were guided solely by fluoroscopy and angiographic imaging of the pulmonary veins, to an approach guided by modern nonfluoroscopic electroanatomical mapping, integrated or not with computed tomography (CT). The aim of this study was, therefore, to compare radiation exposure of RFCA based on a fast three-dimensional nonfluoroscopic mapping system with 'traditional' mapping integrated with CT imaging. METHODS: Thirty consecutive patients with atrial fibrillation who underwent RFCA were treated with two different approaches: 3D-Fast-Anatomical-Mapping and One-Map tool (FAM-One Map group, 21 patients) vs. 3D-Fast-Anatomical-Mapping integrated with CT images (MERGE-CT group, nine patients). Fluoroscopy time and radiation doses (expressed in milliGray) were compared. RESULTS: No statistically significant difference was detectable between FAM-One Map group and MERGE-CT group considering RFCA success rates and fluoroscopy times. Radiation exposure was higher in the MERGE-CT group (965 ± 138 mGy MERGE-CT group vs. 532 ± 216 mGy FAM-One Map group, P < 0.001) because of supplemental radiation exposures due to CT imaging (470 ± 126 mGy). CONCLUSION: A fast nonfluoroscopic electroanatomical mapping system may reduce radiation exposure in RFCA of atrial fibrillation, with preserved success rates.