Average Fluoroscopy Time Research Articles

Clinical experience of pulmonary vein isolation via single transseptal puncture in atrial fibrillation patients: Comprehensive characterization and follow-up

BackgroundAtrial fibrillation is the most commonly observed cardiac rhythm disorder. Pulmonary vein isolation (PVI) is an effective treatment option to maintain sinus rhythm. This study evaluates the safety, efficacy, clinical outcomes and radiation exposures using a standardized single transseptal puncture (STP)-strategy. MethodsWe analyzed data from patients who underwent our STP-ablation technique with transesophageal echocardiography (TEE) guidance at a university hospital and a regional tertiary health center in Switzerland between January 1, 2017, and May 30, 2022. Collected data included demographics, symptoms, echocardiography results, procedural details, complications and outcomes. Mean follow-up time was 21.4 ± 16 months. ResultsThe study population included 304 patients with a median age of 67 years, who had at least one ablation using our STP-approach. Among these, 248 (82 %) patients underwent de novo PVI with this technique. Ablation was successful in all patients with isolation of all pulmonary veins, with an average procedure duration of 120 min and an average fluoroscopy time of 3 min, resulting in a mean X-ray dose of 252 cGy × cm2. TEE guidance was performed in 235 (95 %) patients. During the first intervention, 17 complications occurred in 13 patients (5 %). After the first PVI, 135 (54 %) patients experienced no recurrence during the follow-up period. The one-year recurrence rate for atrial fibrillation requiring therapy was 30 %. ConclusionOur STP- approach demonstrated comparable success rates to traditional methods, with similar procedural durations, low radiation exposure and a low complication rate. Therefore, this method may offer procedural, economic and safety benefits without compromising efficacy or safety.

Comparison of two methods for treatment of 1-2cm kidney stones in pediatric patients: mini PCNL and RIRS.

This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2cm kidney stones in pediatric patients. The records of patients under the age of 18 years who were diagnosed with unilateral 1-2cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.

Safety and Efficacy of Radial Artery Access for Peripheral Vascular Intervention: A Single-Center Experience

Radial artery (RA) access has been increasingly utilized for coronary procedures due to lower rates of access-site complications and improved patient satisfaction. However, limited data are available for RA access for peripheral vascular intervention (PVI). We performed a retrospective review of 143 patients who underwent PVI via RA access from February 2020 to September 2022 at a single institution. Baseline characteristics and follow-up data were ascertained from a prospectively maintained institutional database. Of 491 PVI, 156 (31.8%) were performed through the RA. Anatomical location for intervention were the femoral (44.8%), iliac (31.1%), popliteal (9.6%) peroneal (2.7%), tibial (9.9%), and subclavian (1.9%) arteries. Procedural access was obtained through the right RA (92.9%), left RA (4.5%), or right ulnar artery (2.6%) using the 6 French R2P Destination Slender sheath in 85 cm, 105 cm, and 119 cm lengths. Atherectomy was used in 34.7%. Mean contrast volume was 105.5 mL and the average fluoroscopy time was 18.5 minutes. Conversion to femoral access occurred in 3 cases (1.9%) due to arterial spasm and non-crossable lesions. Concomitant pedal access occurred in 2 cases (1.3%). Periprocedural complication rate was 3.84%, of which access-site hematoma was most common (3.2%); none required blood transfusion, surgical intervention, or additional hospital stay. There was 1 case (0.64%) of in-hospital stroke. The mortality rate at 30-day, 6-month, and 1-year was 1.4%, 2.8%, and 4.2%, respectively. In conclusion, RA access is feasible for diverse PVI, and future studies are needed to assess safety and benefit compared to femoral artery access.

Peripherally Inserted Central Venous Catheter (PICC) Line Use for Conjoined Twins: Single-Center Experience

Abstract Purpose This article assesses the feasibility, safety, and efficacy of peripherally inserted central catheters (PICCs) in conjoined twins. Material and Methods A retrospective chart review of all consecutive conjoined twins who had PICC placement at a tertiary center. Seventeen conjoined twins (12 females; 71%) had 25 PICC insertions. The average age of patients at PICC insertion was 15.9 ± 19.3 months. The most common type of twin was thoraco-omphalopagus (5 patients; 29%). The most common access was the brachial vein (N = 10, 40%). Thirteen procedures (52%) were performed before separation. Results Seven long-term minor complications were identified (28%). The most common complication was malpositioning (8%). Average dwell time was 122 days while the average fluoroscopy time was 2 minutes and 3 seconds. Conclusion Image-guided PICC placement in conjoined twins is safe and feasible. It provides excellent durable vascular access.

Pulsed-field ablation of atrial fibrillation in elderly and frail patients: procedural efficacy and safety from a single-center experience

Abstract Introduction The demographic data shows a growing population, mostly elderly and with multiple comorbidities, therefore becoming increasingly frail. In this context Atrial fibrillation (AF) is the predominant sustained arrhythmia, and over the years trans-catheter isolation of pulmonary veins (PVI) has become a crucial approach in AF treatment. Among the technologies and energy resources employed through the years to perform atrial fibrillation transcatheter ablation, a novel technique has recently begun to gain ground, specifically pulsed-field ablation (PFA). PFA employs sequential brief and high amplitude electrical pulses to induce selective and irreversible electroporation of the myocardium, leading to cell death. The high selectivity of the lesion, ensured by the lower electroporation threshold of myocardial tissue compared to adjacent anatomic structures, allows for a decrease in potential complications associated with conventional thermal ablation. Purpose To assess the efficacy and safety in the use of pulsed field ablation in a selected population of elderly and frail patients undergoing atrial fibrillation ablation. Method We conducted a retrospective study focusing on elderly and frail patients admitted to our centre for paroxysmal or persistent AF ablation. The inclusion criteria were: age greater than 75 years and a Clinical Frailty Scale ≥ 5. The study population consisted of 26 patients [male gender 18, mean age 78 ± 3 years] including 8 who were affected by an oncological or haematological disease at the time of admission. The majority of patients were affected by paroxysmal AF while two of them presented persistent AF (9%). The primary ablation endpoint was the pulmonary vein isolation (PVI) that was achieved by delivering an energy of 2 kV over 8 applications, employing an alternating approach between the two configurations of the basket and flower catheter for each individual vein. Results The short-term success, represented by the complete and verified electrical isolation of the veins was achieved in all 26 patients without any periprocedural complications. First-pass pulmonary vein isolation (FPI) was universally achieved among the patient in study, with a mean skin-to-skin procedural time of 70 ± 30 minutes. From the procedural data perspective, ablation was achieved using an average fluoroscopy time of 22 ± 8.4 minutes and an average dose area product (DAP) of 1320 cGy×cm2. Conclusions In elderly and frail patients, we assessed the efficacy and safety of ablative procedures using the PFA technique. Successful electrical PVI was achieved without additional touch-ups, thanks to a high FPI rate. This results in lower procedural times and shorter intra-operative radiation exposure. These data confer an augmented value within the elderly-frail population, wherein shorter procedural times contribute to a better postoperative course, characterized by reduced bed rest and shorter intra-hospitalization periods.

Use of echocardiography in percutaneous closure of patent ductus arteriosus at the Instituto Nacional de Salud del Niño, San Borja, Lima - Peru.

Percutaneous occlusion of patent ductus arteriosus (PDA) has classically been performed entirely by fluoroscopy, however in recent years, transthoracic echocardiography (TE) has been used as an aid to fluoroscopy or entirely by echocardiography, which avoids access of femoral artery, use of contrast and decrease in time and dose of radiation exposure. The objective of this study was to evaluate the success rate with the use of TE in percutaneous PDA closure. Descriptive, comparative, retrospective study between patients in whom PDA closure was performed with fluoroscopy plus angiography (group 1) and fluoroscopy plus ET (group 2), between January 2018 and December 2022. The data were obtained from the clinical history electronic and procedure report. One hundred eight patients were analyzed, fluoroscopy group (n: 57) and TE (n: 51). The success rate in PDA occlusion using TE was 100% and 98% for the fluoroscopy group, with no statistically significant difference The average age of group 2 was 2.9 years, while the average age of group 1 was 5 years (p=0.001), the average fluoroscopy time in group 1 was 16.9 min and 4.71 min in group 2 (p < 0.001); the fluoroscopy dose in group 1 was 68.98 mGy and 5.17 mGy in group 2 (p<0.001). Krichenko, but without significant difference in both groups. The success rate of percutaneous PDA closure using echocardiography and fluoroscopy is appropiate, with a success rate similar to the classic technique. In addition, it makes it possible to reduce the dose and time of fluoroscopy, avoid the use of contrast, and access the femoral artery.

Is There Still a Learning Curve for Primary TAA After Completing a High Volume Ankle Replacement Fellowship? A Multicentered Study

Introduction/Purpose: The learning curve in Total ankle arthroplasty(TAA) has long been reported. Surgeon experience of five to twenty-five ankle replacements have been shown to decrease various perioperative and long term complications in this complex surgery. Fellowship programs with high-volume ankle arthroplasty experiences have been suggested to mitigate this learning curve and provide benefit to early career surgeons with TAA outcomes. The purpose of this study was to evaluate the learning curve for TAA in two high-volume surgeons practices through the first three years of practice. Both surgeons completed fellowships and participated in more than 100 ankle replacements each. We hypothesized that experience during fellowship will help minimize complications and negate any learning curve previously established in the literature. Methods: Prospectively collected data was retrospectively reviewed on all patients who underwent primary TAA surgery during the first three years of clinical practice after fellowship in this IRB approved, multi-centered study. Patient demographics and clinical data, radiographic outcomes, and patient reported outcomes were collected on all patients. Patients undergoing revision TAA (as a first surgery), patients without a minimum of 2 years follow-up, and patients undergoing arthrodesis conversion to TAA were all excluded. The data was analyzed using Chi Squared test and the Moving Average Method where appropriate. All statistical analysis was performed by someone with an expertise in biostatistics. Results: Eighty-seven patients (67.8% male, avg. age 64) met inclusion criteria for the study. Average tourniquet time (111.9 min) and fluoroscopy time(106.3 secs) decreased as surgeon experience increased, with the this trend stabilizing after patient 20. Complication rate (wound complication, infection, return to OR, intraoperative fracture, etc.) was similar throughout the study period. No differences were seen in component positioning (postop AP TT angle, Postop Lateral TT angle), PROMIS Pain interference, PROMIS Depression, or PROMIS Physical function with regards to time during the study. Statistically significant differences (improvements) were seen in in the following postoperative measurements when compared to preoperative values: AP TT angle, Lateral TT angle, and PROMIS Pain Interference/Depression/Physical function. Conclusion: Learning curve as it relates to intraoperative fluoroscopy time and intraoperative tourniquet time remained even after completing a high volume TAA fellowship but clinical and PROs did not show this same trend. Radiographic measurements, complications (both intraop and postop), and patient reported outcomes did not show a time sensitive change after fellowship. Though some variables did show the maintenance of a learning curve, this multi-centered study suggests that completion of a high volume TAA fellowship can mitigate some variables in the learning curve. Study Data Summary

The Effect of the Use of Activation 3D Mapping on the Patient X-Ray Load During Radiofrequency Ablation of Typical Atrial Flutter

Supraventricular macro re-entry tachyarrhythmias occupy the leading places among all types of tachyarrhythmias. The most common in this category is typical atrial flutter (AFL). This heart rhythm disorder has a negative impact on the patients’ quality of life. Its complications can lead to disability and death due to possible thromboembolism. Therapeutic treatment is limited in effectiveness. The main method of intervention is catheter radiofrequency ablation (RFA). The standard approach of RFA of AFL is performed without the use of navigation systems under fluoroscopy guidance. However, this results in an increased radiation exposure to the patient and the medical personnel. Modern technologies in the field of invasive electrophysiology make it possible to create anatomical models of heart and reproduce the spread of electrical excitation. However, the routine use of additional navigation methods remains controversial.&#x0D; The aim. To compare the duration of RFA of typical AFL and radiation exposure with the use of anatomical and propagation mapping.&#x0D; Materials and methods. This study is based on the analysis of the treatment results obtained for 53 patients at the National Amosov Institute of Cardiovascular Surgery in the period from 2014 to 2023. Depending on imaging methods, the patients were divided into two groups. The first group included 27 patients with an anatomical mapping of the right atrium. The second group included 26 patients with propagation mapping.&#x0D; Results. In all the patients we have achieved a bidirectional conduction block through cavotricuspid isthmus. In the first group, the total duration of confirming the diagnosis and creating the anatomical model was 312 ± 26 seconds. The mean time to the moment of AFL termination and restoration of sinus rhythm was 230 ± 19 seconds. The average duration of the procedure was 41.5 ± 3.5 minutes, the average fluoroscopy time was 120 ± 10 seconds, the average dose area product (DAP) was 15 ± 1.3 Gy·cm2. In the second group, the average time for creating a 3D propagation model of right atrium and verifying the diagnosis was 748 ± 65 seconds. The average time from the first application to the termination of tachycardia was 227 ± 20 seconds. The average duration of the procedure was 55 ± 4.7 minutes, X-ray time was 93 ± 8 seconds, average DAP was 13 ± 1.1 Gy·cm2. The duration of the procedure in the second group was significantly longer (p = 0.03), however, the radiation exposure and DAP were not statistically different (p = 0.31) between the observation groups.&#x0D; Conclusions. The use of propagation mapping increases the time of the procedure by 24.5% and does not give a significant advantage in reducing the radiation exposure. The use of a navigation system during cavotricuspid isthmus RFA is recommended for concomitant radical treatment of complex supraventricular arrhythmias, such as atrial fibrillation.

Focal Pulsed Field Ablation for Atrial Arrhythmias: Efficacy and Safety under Deep Sedation.

Focal pulsed field ablation (PFA) is a novel technique for treating cardiac arrhythmias. It has demonstrated positive results in initial studies and has a good safety profile. In recent studies, PFA was often utilized for first-time pulmonary vein isolation (PVI) and was performed under general anesthesia. In our study, we assessed the feasibility, safety, acute procedural efficacy, and efficiency of focal PFA under deep sedation in patients, 80% of whom had undergone at least one left atrial ablation previously. We treated 30 patients (71 ± 7, 46% male) using the CENTAURI system for various atrial arrhythmias, including atrial fibrillation, typical and atypical atrial flutter, and focal atrial tachycardia. The average procedure and fluoroscopy times were 122 ± 43 min and 9 ± 7 min, respectively. A total of 83.33% of patients received additional line ablations beyond PVI, specifically targeting the posterior box and anterior mitral line. All ablations were successfully performed in deep sedation with only one major and one minor complication observed. The major complication was a vasospasm of the right coronary artery during ablation of the cavotricuspid isthmus, which was treated successfully with intracoronary nitroglycerin. All patients could be discharged in sinus rhythm. Moreover, adenosine appears effective in identifying dormant conduction in some patients after focal PFA. In conclusion, focal PFA is an effective approach for complex left atrial ablations under deep sedation, offering both high efficacy and efficiency with a reliable safety profile. Studies on long-term outcomes are needed.

Intraoperative Radiation Exposure During Midfoot Charcot Reconstruction

While radiation exposure in foot and ankle surgery varies by procedure, attempts to minimize this hazard remain imperative to protect patients and surgeons. Hindfoot deformity correction employs significant radiation through intraoperative fluoroscopy, however, a paucity of data exists concerning Charcot reconstruction. This investigation describes and compares radiation exposure across varying Charcot pathology and fixation constructs. A retrospective chart review of patients undergoing midfoot Charcot reconstruction under large C-arm assistance from 2016-2022 was conducted. Demographics, pathology-specific, and intervention-specific variables were recorded and compared among midfoot reconstructions. The threshold for statistical significance was set at p ≤ .05. Among 40 patients, the average midfoot radiation exposure and fluoroscopy times were 9.5 ± 5.39 mGy and 256.64 ± 130.67 seconds, respectively. There existed no statistically significant difference in radiation exposure (p = .32) or fluoroscopy times (p = .71) among the different midfoot constructs. There existed a statistically significant relationship between radiation exposure with weight (p = .01) body mass index (p = .03) and number of stages (p = .04). Similarly, a relationship existed between fluoroscopy time with weight (p = .02), body mass index (p = .03), and number of beams/screws (p = .003). Due to the complexity of Charcot reconstruction coupled with multiple robust types of fixation, surgeons must remain cognizant of fluoroscopy usage. Moreover, providers who routinely perform Charcot reconstruction should wear personal protective equipment to protect against radiation.

Long-term follow-up of the patients with pacemaker leads implanted through persistent left superior vena cava

Introduction/Objective. Persistent left superior vena cava (PLSVC) is the most common congenital malformation of the thoracic venous system and may often complicate cardiac implantable electronic device (CIED) lead implantation. The purpose of this study was to assess feasibility and safety of CIED lead implantation through PLSVC and its long-term efficacy. Methods. This is a retrospective observational study performed in a tertiary center from July 2005 to July 2019 among patients with fully successful implantation of all intended CIED leads through PLSVC. Results. CIED implantation was successfully completed with left-side approach in 26 of 32 (81.3%) patients with PLSVC. The average implantation time was 62, 73.5, 120, 74, 103.3, and 130 minutes and the average fluoroscopy time was 13.3, 20.8, 35.7, 17.1, 45.6, and 42.6 minutes for single and dual-chamber pacemakers, ICD-VR, ICD-DR, CRT-P, and CRT-D devices, respectively. The average follow-up period was 43.5 ? 29.9 months. During the follow-up period no CIED leads-related complications were noticed. Conclusion. The results of our study showed that the presence of PLSVC is not an obstacle for CIED implantation. The long-term follow-up proved stability of CIED leads implanted through PLSVC.

Abstract 17069: Efficacy and Safety of Pulsed Field Ablation For Atrial Fibrillation: A Systematic Review and Meta-Analysis

Introduction: Pulsed-field ablation (PFA) is a novel ablation modality to treat atrial fibrillation (AF) with high tissue selectivity and thereby potentially lesser complications compared to thermal ablation. Hypothesis: We aimed to analyze the efficacy and safety of PFA in the treatment of AF. Methods: A systematic search of Embase, Medline, Scopus, and Web of Science was conducted from inception till May 2023 to identify all the studies that included patients undergoing pulsed field ablation for the treatment of AF. We pooled outcomes using a random-effects model. All analyses was performed using the OpenMetaAnalyst software. Results: A total of 24 studies including 2,256 patients met our inclusion criteria. Acute isolation of all pulmonary veins was achieved in 99.7% of all patients (95% confidence interval (CI): 99.4%-99.9%; I 2 : 0%). The average total procedure time was 81 (95% CI: 69-93; I 2 : 99%) minutes, and the average fluoroscopy time was 14 (95% CI: 12-16; I 2 : 98%) minutes. The overall complication rate was 2.9% (95% CI: 1.4%-4.0%; I 2 : 71%). At a mean follow-up of 6.6 months, the overall rate of arrhythmia recurrence after the blanking period of 90 days was 17% (95% CI: 11%-24%; I 2 : 94%). Conclusion: PFA has a high procedural success with low complication and recurrence rates. Further randomized controlled trials are needed to compare its long-term efficacy and safety against conventional ablation techniques.

Abstract 18372: Peripheral Intravascular Lithotripsy to Facilitate Transfemoral Transcatheter Aortic Valve Replacement - Updated Outcomes

Background: Transfemoral transcatheter aortic valve replacement (TF-TAVR) approach has proven to be superior to alternative access[1]. However, a subset of patients being evaluated for TF-TAVR are deemed unfit secondary to peripheral arterial disease. Despite reduction of delivery system profiles to 14 - 18 Fr, current systems still pose an increased risk of access vessel injury. For patients anatomically unfit for standard transfemoral access, peripheral intravascular lithotripsy (IVL) has emerged to facilitate femoral access for TAVR. Methods: Single center, retrospective analysis of an institutional patient database, queried from 1/2018 through 12/2022 for all patients undergoing TAVR. All patients undergoing IVL facilitated lithotripsy for transfemoral access were analyzed. Results: A total 2,209 TAVR cases were identified, with 75 (3.78%) having undergone lithotripsy: 14 in 2018, 15 in 2019, 16 in 2020, 13 in 2021, and 17 in 2022. The lithotripsy cohort consisted of 45% female with mean age of 78±9.8 years. Average length of stay was 3 days. Common and external iliac lesions were the most common target (n=41/75), followed by common iliac alone (n=25/75). Majority of IVL was performed with 7-mm lithotripsy catheter (n=55/75). Procedural success was 98.7% (n=74/75). Average fluoroscopy time 31 minutes, and average total contrast infusion 87cc. Average number of pulses per lesion was 260 ±52. Mean target lesion diameter on the right 5.0 ±1.2mm and left 5.3 ±1.3mm. Average aortic valve calcium score was 2405.6 ±1260.4. Total complication rate was 28%. Complications requiring secondary vascular procedure occurred in 5.3% (n=4/75) with femoral stenosis requiring balloon dilation, external iliac pseudoaneurysm and retroperitoneal bleed secondary to common femoral pseudoaneurysm primarily repaired, and CFA occlusion required open endarterectomy. Mortality at 30-days 1.3% (n=1/75). Conclusions: This abstract aims to provide an updated report of a single institution experience for the use of IVL to facilitate transfemoral TAVR. The IVL facilitated TF-TAVR is feasible, safe, and effective at preserving the transfemoral TAVR route in patients with severe peripheral artery disease. [1] Holmes. et al. J Am Coll Cardiol, 2015. 66(25): p. 2813-2823

Abstract 138: Use of a 046” Intermediate Guide Catheter for Mini‐Triaxial Access in Flow Diversion: Multi‐institution Experience

Introduction The latest FDA‐approved intermediate guide catheter, Vecta46, allows for a unique, mini‐triaxial access platform. The size of this catheter allows for 058” guide compatibility, intraluminal accommodation of an 027” microcatheter for flow diverter delivery, and angiographic procedural injections in an 070” guide catheter. Methods We retrospectively identified and analyzed patients who underwent Surpass Evolve flow diversion treatment utilizing the Vecta46 across the senior authors’ institutions. Results The use of the Vecta46 was identified for treatment of 9 aneurysms treated with the Surpass Evolve Flow Diverter (March to April 2023), in patient’s aged 61±3.5 years (range 40‐74 years) with 89% (n=8) female. Aneurysm average size of 4.3±0.47mm, aneurysms originating along the internal carotid artery (n=6) and MCA branches (n=4). Preoperative PRU measured 92 ± 21. Radial access was utilized in 2 cases. Mean Surpass Evolve utilized was 4.4±0.17mm (diameter) by 15.7±0.88mm (length). An 071” guide catheter (Armadillo, Q’Appel Medical) was used in 8 cases. Vecta46 was safely navigated to the supraclinoid ICA segment in all cases. Average fluoroscopy time was 24±3.1 minutes, radiation exposure was 756±259mGy, and verapamil was used in all cases. Technical success was achieved in all cases with adequate vessel wall apposition verified. There were no hemorrhagic complications nor parent vessel wall dissection or vasospasm in the region of the Vecta46 catheter on final control angiography in all 9 cases. Conclusion The new low‐profile Vecta46 intermediate catheter can be safely and effectively utilized in a 6‐French mini‐triaxial system for flow diverter delivery without compromising injection quality, support, or trackability.

Abstract 157: Evaluating the Impact of Pre‐Procedural CTA on Fluoroscopy Time and Conversion Rates

Introduction Cerebral angiography, essential in managing cerebrovascular disorders, exposes patients to ionizing radiation, with dose dependence on procedure complexity, patient's body habitus, and equipment used, raising safety concerns (1,2). Conversion from primary to secondary access site, influenced by anatomical variables, further increases procedure and fluoroscopy time (3). We propose using Computed Tomography Angiography (CTA) prior to DSA for anatomical insights, potentially reducing access site conversion, procedure time, and radiation dose/fluoroscopy time. This study evaluates the impact of pre‐procedural CTA on fluoroscopy time and access site conversion rates. Methods A retrospective chart review was conducted at a single center to collect data for this study. A total of 93 participants who received DSA were evaluated. Variables of interest included whether a CTA was performed prior to DSA, fluoroscopy time, fluoroscopy dose, time per vessel, dose per vessel, average number of vessels imaged, and the conversion rate from radial to femoral access. Descriptive statistics were used to summarize the data, and independent sample t‐tests were conducted to compare the means of continuous variables between the groups that received a CTA Neck prior to DSA and those that did not. All statistical analyses were performed using a significance level of 0.05. Results Out of 93 participants, 61 had a prior CTA neck and 32 did not. The non‐prior CTA group had slightly higher average fluoroscopy time (15.68 vs. 14.30 min, p=0.39) and dose (643.29 vs. 582.90, p=0.37), but lower time per vessel (3.42 vs. 3.65, p=0.58) and higher dose per vessel (162.80 vs. 145.01, p=0.63). They also imaged more vessels on average (4.81 vs. 4.33, p=0.09). Conversion percentage for non‐prior CTA was lower compared to the prior CTA group (6.25% vs. 6.56%) but not statistically significant. Standard deviation for all measures, except for time per vessel, was higher in the non‐prior CTA neck, indicating more variability in this group. Conclusion This retrospective analysis suggests that prior computed tomography angiography (CTA) might lead to reduced fluoroscopy times and dosage during procedures, but the results are not statistically significant at this stage. However, the study indicates that prior CTA cases had a higher percentage of access site conversions, though the sample size was small. Due to these findings, further investigation with a larger sample size is needed to explore these variables more thoroughly. If CTA before digital subtraction angiography (DSA) can indeed decrease procedure time, radiation exposure, and the need for access site conversion, it has the potential to significantly improve functional neurological outcomes. Moreover, it may reduce the occurrence of complications related to radiation exposure and decrease the overall costs associated with performing DSA and related neurointerventions.

Intraoperative Radiation Exposure in Adolescent Idiopathic and Neuromuscular Scoliosis.

Intraoperative imaging is often used to aid pedicle screw placement during scoliosis operations. Higher rates of cancer and death have been observed in orthopaedic surgeons and radiation technologists, including a fourfold higher rate of breast cancer in female orthopaedic surgeons. The purpose of this study was to evaluate variability in intraoperative radiation during spinal fusions for both adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS). A retrospective review of posterior spinal fusion and segmental spinal instrumentation for scoliosis performed by pediatric orthopaedic surgeons from 2017 to 2019 at a single institution was performed. Inclusion criteria included: a diagnosis of AIS or NMS and patients between 8 and 18 years of age. Exclusion criteria included: revision surgery, use of intraoperative navigation, and patients younger than 10 at the time of scoliosis onset within the AIS cohort. Data collected included: preoperative curve, body mass index (BMI), number of levels fused, number of Ponte osteotomies, and fluoroscopy time. One-way analysis of variance tests, Bonferroni post hoc tests, independent t tests, and Pearson correlations were utilized with significance determined at the 95% confidence level (a = 0.05). A total of 148 patients were included in the study. The average fluoroscopy time was 143 ± 67 seconds. Patients with NMS had higher average fluoroscopy times (193 ± 75 s) compared with patients with AIS (129 ± 58 s, P < 0.001). In patients with AIS, fluoroscopy time correlated to the patient's preoperative curve (r = 0.182, P = 0.050). Patients with AIS with fewer than 12 levels fused had significantly less radiation exposure than those with 12 or more levels fused (P = 0.01). When controlling for the number of levels fused, patients with AIS with higher BMIs had significantly greater fluoroscopy times (P = 0.001). In patients with NMS, fluoroscopy time negatively correlated with BMI (r = -0.459, P = 0.009) and positively correlated with a preoperative curve (r = 0.475, P = 0.007). Fluoroscopy times vary greatly during adolescent spinal fusions for scoliosis. Longer fluoroscopy times are correlated with: NMS diagnosis, larger preoperative curve, BMI, and number of levels fused. Surgeons' knowledge of factors affecting fluoroscopy time will increase awareness and may be the first step in decreasing intraoperative radiation risks. Level III; Therapeutic-a retrospective study.

The use of three-dimensional navigation and advanced intraoperative imaging in minimally invasive pelvic and acetabular fracture fixation: A systematic review

Pelvic and acetabular fractures are challenging injuries to treat. This review evaluates three-dimensional intraoperative imaging and navigation-guided percutaneous SI, trans-iliac, trans-sacral, and acetabular screw placement versus conventional methods performed with C-arm imaging. A systematic search of MEDLINE, Embase, and Cochrane was performed. Two reviewers independently extracted data into a collaborative data form designed a priori and piloted prior to its use. Descriptive statistics are presented where applicable. Summary statistics analysis was presented based on the fracture type. Continuous data such as fluoroscopic and operative time were compared with unpaired Student t-test and pooled data of revision rate and complications were compared with chi-square analysis with an alpha set at 0.05. The rate of complications using conventional fluoroscopy was 11.3% (26/230) compared to three-dimensional navigation (6.7% (40/597), X2 (DF: 1, N = 827) = 4.79, p = .028.) which translated to a higher rate of revision surgeries in the conventional fluoroscopy group (10.9% vs. 0.8%) X2 (DF: 1, N = 827) = 47.8, p ≤.001. Average fluoroscopic time was lower for studies using three-dimensional navigation (28.8 ± 14.3 s, n = 71) compared to conventional fluoroscopy (57.8 ± 4.2 s, n = 38, p ≤.001). Three-dimensional navigation during minimally invasive pelvis and acetabular fracture fixation may have some benefits. Level of evidence: IV.

Wave speed guided point-by-point cavo-tricuspid isthmus ablation to reduce ablation and fluoroscopy in typical atrial flutter

Abstract Funding Acknowledgements Type of funding sources: None. Background Ablation procedures for cavo-tricuspid isthmus (CTI) dependent typical atrial flutter (AFL) have traditionally been performed with conventional electrophysiology mapping guided by fluoroscopy. Three-dimensional electroanatomical mapping (EAM) systems have routinely been used to guide ablation of more complex arrhythmias, but in recent years, have been used for simple ablations with the aim of reducing irradiation. High voltage regions in the CTI have been described as a target in order to minimize procedure times, but there is a lack of knowledge regarding the utility of slow conduction zones for this purpose. Methods In a prospective cohort of patients undergoing 3D EAM assisted AFL ablation, we evaluated a novel strategy (NS) based on omnipolar vectors, using both wave speed and voltage information to focus radiofrequency (RF) lesions (see figure), and compared with a recent retrospective cohort of patients undergoing voltage-guided ablation (VG). Results A group of 26 consecutive patients with mean age 68±12 years and 88% male, underwent NS ablation, and were compared to 23 patients undergoing VG ablation, with no differences among patient characteristics. Of the 26 patients in group NS, 16 (53.9%) were successfully ablated targeting only 2 sites, representing the 2 most confluent areas of low wave speed and high voltage. A total of 24 (92.5%) were ablated successfully with targeting all sites of low wave speed. Only a single patient in the NS group required the completion of a classic CTI line. Average fluoroscopy time and radiation dose were lower in the NS group compared to VG group (1.1±2.4 min 19.5±41.7 mGray vs 8.2±10.2 min and 64.4±76.5 mGray, p=0.0014 and p=0.013, respectively). Furthermore, RF time trended towards reduction in the NS group. Conclusions A strategy based on targeting only areas of low wave speed is effective, limiting the need to complete a traditional CTI line, and reducing fluoroscopy in patients undergoin CTI ablation.

PO-05-111 IMPLANTING A NOVEL ACTIVE-FIXATION LEADLESS PACEMAKER: A SINGLE CENTER EXPERIENCE WITH THE AVEIR VR

The new Aveir VR (Abbott Medical, CA) active-fixation leadless pacemaker (LP) offers several novel innovations. It uses a unique mapping capability to help reduce repositioning attempts prior to fixation and utilizes a helical fixation mechanism for implantation and chronic retrieval. We describe the current largest real world descriptive single center experience with the new Aveir VR LP. This retrospective study describes the characteristics and outcomes of patients who underwent implantation with the single chamber Aveir LP between May 2022 and December 2022. Data was collected from patients’ electronic medical records, dictation forms and procedural logs. Variables collected included demographics (eg age, sex, race), procedural characteristics (eg procedure length, fluoroscopic duration), hospital length of stay and time to discharge, pacing parameters and complications. A total of 48 patients underwent implantation with the single chamber Aveir LP. The most common indications were symptomatic bradycardia due to sinus node dysfunction (55%) and atrial fibrillation with bradycardia (29%). The average age of patients was 72.5 years, 51% were male, and 53% were African Americans. The average procedure duration was 34.3 minutes (range 15–106) and average fluoroscopy time was 13.4 minutes (range 1.4–41.6). Procedure duration improved from a median of 36.0 minutes in the first 10 cases to a median time of 26.0 minutes in the last 10 cases done by the same operator. The average number of mapping locations was 1.6 prior to fixation, implant location was low septal in 84% of patients, and 8.3% of patients required repositioning. The average R wave amplitude at implant was 8.3 mV (range 3.0–18), average impedance was 789 Ω (range 380–1800), and average pacing threshold was 0.87V (range 0.25–2.5) at 0.4ms. There were no periprocedural complications with any of the implantations. The average hospital length of stay was 13 days (range 0.5–63), however the average time from implant to discharge in patients presenting electively was 15 hours. Our experience demonstrates that implantation of the single chamber Aveir VR LP has been safe and effective and is comparable to trial data.

PO-02-053 CHRONIC RETRIEVAL OF NANOSTIM ™ LEADLESS PACEMAKER (LP) FOR RIGHT VENTRICULAR PACING

Leadless cardiac pacemakers (LCPs) are an effective and safe alternative to transvenous pacemakers for single-chamber ventricular pacing. Feasibility of retrieving and replacing long-term implanted LCPs is not well established. We report a small single center series of chronically implanted Nanostim LCP™ leadless pacemakers. Since 2012 there were 103 Nanostim LCP™ devices implanted successfully to the right ventricle (RV) position. In 45 patients (M 26/ F 19), Ø age 72,5± 17 years, with average time since LCP implant of 15470 ± 479 days retrieval procedure was indicated. The main indication for LCP extraction was battery depletion indicative of a battery chemistry issue. Under fluoroscopy we observe the movement and location of LCP. Single snare (42) or triple snare (3) retrieval catheter was introduced through right femoral venous puncture. With deflection we snare the docking bottom and apply counter-clockwise rotation to release the LCP from tissue insertion.Besides fluoroscopy we guided the retrieval procedure with intracardiac echocardiography (ICE). The retrieval procedure was successful in 39 out of 45 patients (86,6%). Average time of the index retrieval procedure was 57 ± 21 minutes and average fluoroscopy time was 11.6 ± 5.2 minutes. New LP system was implanted in 37 patients during the same procedure. When the “swinging” LCP movement was observed, then we were able to retrieve (31 out of 31 patients (100%) vs restricted movement 7 out of 14 patients (50%); p < 0.001. Fluoroscopy time was as well shorter with “swinging” LCP movement (12.7 ± 8.6 min) vs restricted movement (45.6 ± 19 min); p < 0.001. This single center retrieval experience demonstrates the feasibility of replacement long-term implanted Nanostim LCP. The screw-in mechanism and dedicated