SANS FLUORO (SAy No Series to FLUOROscopy): A First-Year Experience

This was a retrospective, single-center, single-operator study examining the safety, feasibility, and short-term efficacy of treating patients with predominantly persistent atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI) with or without cavo-tricuspid isthmus (CTI) ablation by a first-year electrophysiologist (EP) with and without fluoroscopy. The study included 72 consecutive patients undergoing PVI for symptomatic drug refractory paroxysmal (30%) and persistent (70%) AF from August 1, 2015 to August 1, 2016. Fifty-two patients who underwent traditional PVI (30 with radiofrequency (RF) and 22 with cryoablation) with fluoroscopy were compared to 20 patients who underwent RF PVI without fluoroscopy. RF PVI utilized the CARTO s 3-D mapping system (Biosense Webster Inc, Diamond Bar, CA) with a contact force-sensing catheter. All transseptal access was achieved with intracardiac ultrasound (ICE). More patients in the NO fluoroscopy group had coronary artery disease (CAD), but there were no significant differences for other clinical variables. Overall, procedure time was less in the NO fluoroscopy group despite similar ablation times. There was no significant difference in complication rates including vascular complications, tamponade, stroke, and death. Maintenance of sinus rhythm was the same in both groups (70% in the Fluoro group and 68% in the NO Fluoro group). AF ablation with PVI in predominantly persistent patients using RF with NO fluoroscopy in a new operator is feasible and safe with similar short-term efficacy with 3-D electroanatomic mapping in conjunction with contact force-sensing catheters.