Journal Article

Effective reduction of fluoroscopy duration by using an advanced electroanatomic-mapping system and a standardized procedural protocol for ablation of atrial fibrillation: ‘the unleaded study’

Sven Knecht, Christian Sticherling, Tobias Reichlin, Nikola Pavlovic, Aline Mühl, Beat Schaer, Stefan Osswald and Michael Kühne

in EP Europace

Published on behalf of The European Society of Cardiology

Volume 17, issue 11, pages 1694-1699
Published in print November 2015 | ISSN: 1099-5129
Published online May 2015 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/euv006
Effective reduction of fluoroscopy duration by using an advanced electroanatomic-mapping system and a standardized procedural protocol for ablation of atrial fibrillation: ‘the unleaded study’

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Aims

It is recommended to keep exposure to ionizing radiation as low as reasonably achievable. The aim of this study was to determine whether fluoroscopy-free mapping and ablation using a standardized procedural protocol is feasible in patients undergoing pulmonary vein isolation (PVI).

Methods and results

Sixty consecutive patients were analysed: Thirty consecutive patients undergoing PVI using Carto3 were treated using a standardized procedural fluoroscopy protocol with X-ray being disabled after transseptal puncture (Group 1) and compared with a set of previous 30 consecutive patients undergoing PVI without a specific recommendation regarding the use of fluoroscopy (Group 2). The main outcome measures were the feasibility of fluoroscopy-free mapping and ablation, total fluoroscopy time, total dose area product (DAP), and procedure time. Sixty patients (age 60 ± 10 years, 73% male, ejection fraction 0.55 ± 0.09, left atrium 42 ± 8 mm) were included. In Group 1, total fluoroscopy time was 4.2 (2.6–5.6) min and mapping and ablation during PVI without using fluoroscopy was feasible in 29 of 30 patients (97%). In Group 2, total fluoroscopy time was 9.3 (6.4–13.9) min (P < 0.001). Total DAP was 13.2 (6.2–22.2) Gy*cm2 in Group 1 compared with 17.5 (11.7–29.7) Gy*cm2 in Group 2 (P = 0.036). Total procedure time did not differ between Groups 1 (133 ± 37 min) and 2 (134 ± 37 min, P = 0.884).

Conclusion

Performing mapping and ablation guided by an electroanatomic-mapping system during PVI without using fluoroscopy after transseptal puncture using a standardized procedural protocol is feasible in almost all patients and is associated with markedly decreased total fluoroscopy duration and DAP.

Keywords: Atrial fibrillation; Pulmonary vein isolation; Fluoroscopy; Radiation; Mapping systems

Journal Article.  3953 words.  Illustrated.

Subjects: Cardiovascular Medicine

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