Fluoroless and contrast-free catheter ablation without a lead apron in routine clinical practice

Figures

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  Figure 1. Catheters visualization in case with PSVT and AFL. (A) For PSVT case, CS and His catheter was DecaNav. HRA and RV catheter were quatropolar catheter. As HRA and RV catheters could not visualized simultaneously, the cable was switched sequentially to visualize the catheters. (B) RV catheter was visualized in RAO view. (A, B) were same PSVT patient associated with left sided accessory pathway. RA and LA geometry were collected by ICE. (C) Halo catheter and ablation catheter were visualized in AFL case. Halo catheter was positioned around tricuspid valve. RA geometry was collected by ICE. RA right atrium, LA left atrium, HRA high right atrium, RV right ventricle, CS coronary sinus, ABL ablation catheter.

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  Figure 2. Positioning of Esophaster without fluoroscopy. Esophageal ECG was monitored simultaneously during delivery and precise position was assessed. (A) The precise position of Esophaster was considered as the point which (A) wave was detected by proximal electrode. During ablation, Esophaster was visualized and if the position was not appropriate, position was adjusted during ablation. (B) Electrocardiogram recorded by Esophaster. ESO4-5 was proximal electrode. Esophaster was placed in ideal position when proximal electrode was the fastest site of atrial EGM deflection. (A) shows atrial EGM and V shows ventricular EGM. AP antero-posterior, ABL ablation catheter, LA left atrium, LSPV left superior pulmonary vein.

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  Figure 3. Trans-septal puncture without fluoroscopy. (A) The ablation catheter was placed on the atrial septum. (B) The sheath (SL0) was advanced till contact force indicator turn to “SH”. (C) Ablation catheter was removed from the sheath. Tenting of atrial septum was observed. (D) RF needle inserted into inner sheath of SL0 was inserted into the sheath (outer sheath of SL0) and advanced to atrial septum. Tenting of the fossa ovale by RF needle was observed. LA left atrium.

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  Figure 4. Comparison of procedure time required in conventional fluoro group and fluoroless group. Total procedure time were 149 ± 51 min and 162 ± 43 min in fluoro group vs. fluoroless group. Procedure time in PSVT were 170 ± 53 min vs. 162 ± 29 min. Procedure time in AFL were 110 ± 70 min vs. 123 ± 43 min. Procedure time in AF were 162 ± 43 min vs. 163 ± 32 min. There were no significant differences in fluoro group and fluoroless group. PSVT paroxysmal supraventricular tachycardia, AFL atrial flutter, AF atrial fibrillation, N.S. no significant differences.