176-04: Completely Fluoroless Ablation of Cardiac Arrhythmias: a 5-year Experience

Abstract

Background: Catheter ablations have been traditionally performed with the use of fluoroscopic guidance, which exposes the patient and staff to the inherent risks of radiation. In consideration to this risk, many electrophysiology laboratories seek to reduce fluoroscopy time. We have developed techniques to eliminate the use of fluoroscopy during cardiac ablations and have been performing completely fluoroless catheter ablations for the past 5 years. To our knowledge no sizeable dataset on this subject has been published. Results: Specific numbers for each arrhythmia subtype will be presented in detail in the manuscript. In grouping all arrhythmia types, mean follow up was 21.1 months. Mean procedure time was 173.2 minutes, range 22.0–501.0 minutes. Recurrence of arrhythmia was seen in 40 patients (9.0%). Major complications occurred in 5 patients (1.1%), 4 patients had pericardial effusion with tamponade, 1 patient atrial esophageal fistula. No deaths occurred. Minor complications occurred in 3 patients (0.7%), 1 patient had pericardial effusion without cardiac tamponade, 1 patient had a groin pseudoaneurysm, and 1 patient had minor arterial bleeding that did not require transfusion. Fluoroscopy was used in one case (0.02%) for 0.2 minutes due to difficult venous access. Conclusions: Completely fluoroless catheter ablations may be safely performed and without adding time to the procedure as traditionally performed with fluoroscopy. The advent and continued improvement of ICE and EAM has enabled us to rely solely on these modalities for catheter guidance, rendering fluoroscopy as an obsolete imaging technique in our ablation laboratory.