Abstract
Electroanatomic mapping (EAM) systems facilitate the elimination of fluoroscopy during electrophysiologic (EP) studies and ablations. The rate and predictors of fluoroscopy requirements while attempting fluoroscopy-free (FF) ablations are unclear. This study aimed (1) to investigate the rates of fluoroscopic use and acute success in patients initially referred for FF ablation and (2) to identify procedural characteristics associated with fluoroscopic use in patients in whom FF ablation was initially planned (IFF). We performed a retrospective review of all patients who underwent IFF EP study or ablation between 2010 and 2013. Patient and procedural characteristics were compared between those with successful FF procedures and those who subsequently required fluoroscopy during their procedure. An FF EP study with or without ablation was performed in 124 patients during 138 procedures for either supraventricular or idiopathic ventricular arrhythmias. Of the 138 procedures, 105 of them were performed without fluoroscopy. In the remaining 33 cases, fluoroscopy was used for an average of 1.21 minutes ± 1.18 minutes. Acute procedural success was achieved in 97% of both FF and fluoroscopy procedures. The primary reason for fluoroscopy use was as a guide for transseptal puncture. There were no significant differences between FF and fluoroscopy procedures with respect to catheter placement time or complication rate. In conclusion, in this single-center study of IFF procedures, despite careful case selection for IFF ablation, 24% of IFF cases ultimately required minimal fluoroscopy. Fluoroscopy and FF procedures had similar rates of procedural success and complications. Additional large prospective studies are required to further investigate the safety and efficacy of FF ablations.
Highlights
The cumulative effect of ionizing radiation exposure from fluoroscopy used for percutaneous interventional procedures has become an increasingly important topic for the electrophysiologic (EP) community and patients
A total of 138 IFF cases for EP study with or without ablation in 124 unique patients from February 2010 to August 2013 were included for analysis
A minor/transient complication occurred during one ablation with fluoroscopy (3.03%). In this cohort of adult and pediatric patients, we demonstrate that FF ablation has a high procedural success rate and a low risk of complications, though minimal fluoroscopy use may occur, especially if left atrial access is required
Summary
The cumulative effect of ionizing radiation exposure from fluoroscopy used for percutaneous interventional procedures has become an increasingly important topic for the electrophysiologic (EP) community and patients. Outcomes During Intended Fluoroscopy-free Ablation aprons worn by physicians and staff leave areas exposed and have led to cancers of the bone marrow and brain.[2] the use of lead aprons places operators and staff at risk of occupational orthopedic injury.[3]. With improved precision in anatomical resolution with EAM systems, the use of either very little or no fluoroscopy have become viable options for EP studies and ablations. The aim of the present investigation was to compare the rates of fluoroscopic use and the outcomes of patients referred with the intention to receive a fluoroscopy-free (FF) (IFF) procedure
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