Catheter ablation of atrial fibrillation without the use of fluoroscopy

Background

In performing catheter ablation of paroxysmal atrial fibrillation (PAF), the advent of electroanatomical mapping (EAM) has significantly reduced fluoroscopy time. Recent advances in the ability of EAM systems to simultaneously visualize multiple catheters have allowed some operators to perform certain procedures, such as catheter ablation of supraventricular tachycardias, with zero fluoroscopy use.

Objective

The purpose of this study was to evaluate the feasibility and safety of pulmonary vein (PV) isolation with zero fluoroscopy use, using a combination of three-dimensional EAM and intracardiac echocardiography (ICE).

Methods

Using the NavX EAM system, the right atrial (RA) and coronary sinus (CS) geometries were created without fluoroscopy. Fluoroless transseptal puncture was performed under ICE guidance. Using a deflectable sheath and a multipolar catheter, the left atrial (LA) and PV anatomies were rendered and, in select cases, integrated with a three-dimensional computed tomography (CT) image. Irrigated radiofrequency ablation was performed to encircle each pair of ipsilateral PVs.

Results

This series included 20 consecutive PAF patients. RA/CS mapping required 5.5 ± 2.6 minutes. In all patients, single (n = 18) or dual (n = 2) transseptal access was successfully achieved. The LA-PV anatomy was rendered using either a circular (14 patients) or penta-array (six patients) catheter in 22 ± 10 minutes; CT image integration was used in 11 patients. Using 49 ± 18 ablation lesions/patient, electrical isolation was achieved in 38/39 ipsilateral PV isolating lesion sets (97%). The procedure time was 244 ± 75 minutes. There were no complications.

Conclusion

Completely fluoroless catheter ablation of paroxysmal AF is safely feasible using a combination of ICE and EAM.

Keywords: Atrial fibrillation, Fluoroscopy, Catheter ablation, Electroanatomical mapping, Radiofrequency, Radiation, Fluoroless, ICE, Ultrasound, Pulmonary vein

Abbreviations: AF, atrial fibrillation, CS, coronary sinus, CT, computed tomography, EAM, electroanatomical mapping, ICE, intracardiac echocardiography, IVC, inferior vena cava, LA, left atrial, PAF, paroxysmal atrial fibrillation, PV, pulmonary vein, RA, right atrial, RF, radiofrequency, SVC, superior vena cava, SVT, supraventricular tachycardia