Abstract 15749: Outcomes of Fluoroless vs. Fluoroscopy-Guided Left Atrial Appendage Electrical Isolation During Catheter Ablation of Atrial Fibrillation

Abstract

Introduction: Fluoroscopy-guided catheter ablation remains a common practice. With the presence of technologies such as intracardiac echocardiography (ICE) and electroanatomic mapping (EAM), it is possible to perform fluoro- and lead-free procedures to avoid the hazards of prolonged radiation exposure. Left atrial appendage electrical isolation (LAAEI) is a proven e!ective ablation strategy for atrial fibrillation (AF). We sought to assess the characteristics, complications, and outcomes of fluoroscopy-guided LAAEI and compare them to fluoroless LAAEI. Methods: We retrospectively analyzed patients with AF who underwent LAAEI as part of their ablation procedure. The study group included patients who underwent LAAEI either under fluoroscopy guidance or with ICE and EAM alone. We analyzed outcomes and procedural data, including procedural times, fluoroscopy times, radiation exposure (mGy), and radiofrequency times. Results: Overall, we analyzed 168 patients who underwent LAAEI; 110 under fluoroscopy guidance and 58 fluoroless. The mean procedural time was similar in both groups (248 ± 101 vs 264 ± 83 minutes, respectively, p=0.27). The mean RF time was longer in the fluoroscopy-guided group (50 ± 28.2 compared to 43 ± 17.1 minutes, respectively, p<0.001).The mean fluoroscopy time in the fluoroscopy-guided group was 25.3 ± 24.7 minutes, with mean radiation exposure of 177 ± 389 mGy. There was no difference in procedure-related complication rates ( 7 [6.3%] vs 4 [6.9%], respectively, p=0.89). At follow-up, there was no significant difference in arrhythmia recurrence rates (40.9% vs 31%, p=0.21). Conclusion: Fluoroless LAAEI is a safe and e!ective alternative to fluoroscopy-guided ablation, with the added benefit of averting the risks of ionizing radiation exposure. 1