176-05: Low Fluoroscopic Protocol for Ablation of Atrial Fibrillation: Utilization of 3-dimensional Mapping to Facilitate Leadless Post-Transeptal Procedure

Abstract

Background: Live fluoroscopic imaging continues to be an important tool in atrial fibrillation (AF) ablation. The availability of 3-dimensional (3D) mapping systems, intracardiac ultrasound, and other adjuvant technologies (CARTO-UNIVU and MediGuide) have helped to reduce fluoroscopic exposure in the electrophysiology lab. We report the results of a low-fluoroscopic protocol for ablation of AF that relies primarily on 3D mapping. Methods: 28 consecutive patients referred for AF ablation underwent ablation for AF utilizing a low fluoroscopic protocol. All catheters were placed without the use of fluoroscopy. Right and left atrial anatomy were created using Fast Activation Mapping (FAM) utilizing Biosense Webster's CARTO 4 navigation system. Double transeptal puncture was achieved using a combination of intracardiac ultrasound and limited fluoroscopic imaging. Following transeptal access, lead protection was discontinued and no fluoroscopy was employed for the remainder of the case. In select cases linear ablation, and ablation of the cavo-tricuspid isthmus were performed. Results: Pulmonary venous isolation was achieved in 100% of cases (Table 1). Of the patients in our cohort, 57% were classified as Long Standing Persistent AF. The median fluoroscopic time for this protocol was 1.55 minutes IQR (1.3, 2.2). Median radiation dose was 32 mGy. No complications occurred. Procedural Data for Atrial Fibrillation Ablation Procedures Procedural Data for Atrial Fibrillation Ablation Procedures Conclusions: A low fluoroscopic protocol utilizing primarily CARTO 4's navigation system is achievable and safe. Our protocol results in fluoroscopic times, and radiation exposure are equivalent or superior to previously published protocols Further studies will help to further refine the use of low fluoroscopic protocols in the ablation of atrial fibrillation.