PO-02-141 SEEING THE HEART WITHOUT FLUOROSCOPY: ADVANCES IN AF ABLATIONS

Abstract

Fluoroscopic imaging has historically played a critical role in interventional electrophysiology (EP). However, ionizing radiation carries significant and well-documented risks to both patients and staff. Advancements in non-fluoroscopic imaging methods, via electroanatomic mapping and intracardiac echocardiography, have provided electrophysiologists with the technology for performing catheter ablations with minimal to no fluoroscopic radiation. Through various fluoroscopy reduction techniques, there is now a means to reduce fluoroscopy exposure during each step of an atrial fibrillation (AF) ablation. Assess how the utilization of fluoroscopy reducing techniques over time has contributed to electrophysiologists performing AF ablations (both paroxysmal and persistent) with minimal to zero use of fluoroscopy. We reviewed 6240 AF ablations from 2009 to 2022 performed at Brigham and Women’s Hospital by electrophysiologists utilizing minimal fluoroscopy as well as those performing fluoroscopy-free ablations. Procedure characteristics include percentage of cases that were performed without the use of fluoroscopy as well as the trend in both fluoroscopic dose and time per case. Of the 6240 (4025 (65%) and 2215 (35%) paroxysmal and persistent, respectively) AF ablations performed since 2009, 1129 (18.1%) have been performed without the use of fluoroscopy. However, since 2017, which was the first year a fluoroscopy-free ablation was performed, 40.9% of ablations have been performed without fluoroscopy. For the most recent year 2022, of the 622 ablations performed, 356 (57.2%) were performed without the use of fluoroscopy. Since 2017, there is no difference in intraprocedural complications in cases performed without fluoroscopy compared to those with fluoroscopy (0.8 % vs 0.9%; P=0.55). There was also an overall reduction in the average fluoroscopy time (excluding non-fluoroscopy operators) with the average time in 2022 being 7.399 minutes, as compared to the average fluoroscopy time in 2017 of 22.329 minutes. Through advancements in fluoroscopy reduction techniques and imaging technologies, there has been a trend towards an AF ablation being performed predominantly without the use of fluoroscopy without an increase in intraprocedural complications. Amongst electrophysiologist who continue to use fluoroscopy, incorporation of these fluoroscopy reduction techniques has also led to a significant reduction in overall per case fluoroscopic time.