Key result
3D mapping-guided radiofrequency balloon ablation significantly reduced fluoroscopy time compared to fluoroscopy guidance alone (median 7.0 vs 10.5 minutes, p<0.005), with comparable rates of durable isolation and freedom from atrial tachyarrhythmias.
Why the study?
Fluoroscopy for radiofrequency balloon positioning during PVI exposes patients to radiation, prompting evaluation of 3D electroanatomical mapping to potentially reduce radiation while maintaining procedural efficacy and durability.
Does 3D electroanatomical mapping guidance reduce fluoroscopy time and maintain PVI durability compared to fluoroscopy alone during radiofrequency balloon ablation?
Cohort (n=60)
Single-blind (operator blinded to mapping system in control group)
None (consecutive assignment)
No
Does 3D electroanatomical mapping guidance reduce fluoroscopy time and maintain PVI durability compared to fluoroscopy alone during radiofrequency balloon ablation?
Absolute Event Rate: 7% vs 10.5%
p-value: p=<0.005
The addition of 3D electroanatomical mapping to radiofrequency balloon ablation significantly reduces fluoroscopy time and dye consumption while maintaining high rates of durable pulmonary vein isolation.
May lower radiation exposure during ablation; leaves open whether 3D mapping improves outcomes in randomized trials.
Background Effective balloon positionnking during pulmonary vein isolation (PVI) with a radiofrequency balloon (RFB) is crucial for optimal energy delivery, maximising lesion formation, and preventing gaps. Traditionally, fluoroscopy is used to guide pulmonary vein (PV) occlusion, however, this method exposes patients to radiation. Recently, RFBs equipped with 3D electroanatomical mapping (EAM) offer an alternative approach, potentially achieving the same results with reduced radiation exposure. Our main aim was to evaluate procedural characteristics, such as acute isolation and time-to-isolation (TTI), when the RFB is positioned based only on fluoroscopy feedback vs. fluoroscopy and a 3D-EAM. The secondary objective was to assess PVI durability through mandated remapping in asymptomatic patients from both groups. Methods A total of 60 patients were enrolled and underwent either a fluoroscopy-guided (FLUO, 30 patients) or fluoroscopy + 3D-EAM (3D-MAP, 30 patients) ablation. In each group, 15 patients without any documented recurrence underwent protocol-mandated repeat 3D-EAM six months after the index ablation. Procedural outcomes, lesion metrics, and safety profiles were assessed and compared between groups. Results At a median follow-up of 579 days, freedom from any atrial tachyarrhythmias (ATAs) was 89.7% in the FLUO group and 92.3% in the 3D-EAM group ( P > 0.05). The latter was associated with significantly reduced fluoroscopy exposure (median 10.5 vs. 7.0 min, P < 0.005). Procedure time and efficacy metrics, including single-shot isolation rates and TTI, were comparable between groups. Durable PVI on a per PV basis was present in 54/60 (90%) vs. 57/60 (94%) of PVs in the FLUO and 3D-EAM groups, respectively ( P = 0.9). Conclusion Radiofrequency balloon led to a high rate of durable PVI whether its guided by fluoroscopy only or 3D mapping. The latter allowed avoiding dye comsuption and a reduction of fluoroscopic times.
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Almorad et al. (2025) conducted a cohort in Paroxysmal atrial fibrillation (n=60). 3D mapping-guided radiofrequency balloon ablation vs. Fluoroscopy-guided radiofrequency balloon ablation was evaluated on Fluoroscopy time (minutes) (p=<0.005). 3D mapping-guided radiofrequency balloon ablation significantly reduced fluoroscopy time compared to fluoroscopy guidance alone (median 7.0 vs 10.5 minutes, p<0.005), with comparable rates of durable isolation and freedom from atrial tachyarrhythmias.
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