Difference In Fluoroscopy Time Research Articles

Leadless pacemaker implantation versus conventional transvenous cardiac pacing early after transcatheter aortic valve replacement: a safe and relevant option?

Abstract Background Leadless pacemakers (LPM) are known to have lower postoperative complications than conventional transvenous cardiac pacing especially in frail patients (pts) with many comorbidities. The aim of this study was to assess the "real-life" feasibility and outcomes of LPMs compared to transvenous pacemakers (TPMs) in patients who underwent transcatheter aortic valve replacement (TAVR). Methods This is a retrospective single center study including all consecutive patients who received LPM or TPM (either single or double chamber) implantation early after a TAVR over a one-year period since September 2022 with a follow up period of at least 3 months. Results 71 pts were included (mean age 82,56 ± 7,1 years old). 16 pts underwent LPM implantation (22,5%). Leadless system pacing was preferred in pts with history of active systemic infection 43,8%, complex conventional vascular approach 12,5 %, deterioration of general condition and clinical frailty 18,8% and history of breast cancer in 25 % pts. Mean time between appearance of conductive disorders and pacemaker implantation was longer (2,9± 2,8 vs 1,5 ± 1,3 days; p=0,06) in the LPM group probably due to organizational issues. Procedure duration was significantly shorter in the LPM group (46 ±20,5 vs 69 ± 21,1 min; p = 0,01). There was no statistically significant difference in fluoroscopy time between the 2 groups even though this parameter was longer in the LPM group (6,8 min vs 5,6 min; p = 0,413). Significantly lower thresholds were observed in pts with LPM implantation (0,45 ± 0,33 vs 0,66 ± 0,25 V; p = 0,017) with no statistically significant difference between the 2 groups concerning the per-operative impedance value. Median time from pacemaker implantation to discharge was 3,12 ± 3,26 vs 4,78 ±7,16 days after LPM and TPM implantation respectively (p = 0,195). There were less complications in the LPM group (1,4 % vs 9,9 %; p = 0,471). Complications were: arteriovenous fistula for 1 pt with LPM vs 2 pocket hematomas, 1 pneumothorax, 1 per-operative cardiac arrest and 3 leads dislodgements in pts with TPM. The mortality rate was significantly higher in the LPM group (4,2 % vs 2,8 %; p = 0,038) although no pacemaker related deaths were reported in both groups and no significant difference between the 2 groups was noted concerning rehospitalisations for cardiovascular cause (p= 0,407). Conclusion Early LPM implantation after TAVR is a feasible alternative to conventional pacing with significantly shorter procedure durations and better pacing thresholds. Our experience confirms the global clinical frailty of patients receiving LPM after TAVR but underlines the favorable safety profile of leadless system pacing with a low rate of complications.

Safety and feasibility of zero-fluoroscopy technique in ablation-index guided pulmonary vein isolation: a prospective, single center trial

Abstract Introduction Pulmonary vein isolation (PVI) represents the cornerstone of catheter ablation procedures in patients with symptomatic paroxysmal/persistent atrial fibrillation (AF). Conventionally, PVI is performed using fluoroscopy, but it can also be performed using the zero-fluoroscopy (ZF) technique with the assistance of electroanatomical mapping systems and intracardiac ultrasound, achieving fluoroscopy-free procedures. Purpose Our study aimed to compare procedural data of ablation-index guided point-by-point radiofrequency (RF) PVI performed with non-zero-fluoroscopy (NZF) vs. ZF approaches. Methods We enrolled 100 consecutive patients undergoing PVI for antiarrhythmic drug- refractory AF in our prospective observational study. In the first 50 cases, PVI was performed using the NZF technique, and in the other 50 cases, the ZF technique was applied. Procedural time, fluoroscopy exposure, ablation parameters, and the occurrence of complications were compared between the two groups. Results Compared to the NZF group, procedural time (59.6±10.7 min vs. 74.6±13.2 min, p<0.0001) was significantly shorter in the ZF group. This difference was mainly driven by the time from puncture to the beginning of left atrial mapping, which was significantly longer in the NZF group (17 [16; 20] min vs. 31 [23; 34.5] min, p<0.001). No differences were found between the two approaches in the number of RF applications (81 [73; 103] vs. 83 [71; 91], p=0.67), total ablation energy (54986 ± 13093 Ws vs. 55500 ± 11907 Ws, p=0.48), and the left atrial dwelling time (41.5 [36; 52.5] min vs. 40.5 [35; 46], p=0.14). No complications occurred in either group. In the ZF group, complete elimination of fluoroscopy was achieved in all cases, resulting in significant differences in fluoroscopy time (0 [0; 0] sec vs. 132 [100; 160] sec, p<0.0001] and dose (0 [0; 0] mGy vs. 4.8 [4.1; 8.2] mGy, p<0.0001) compared to the NZF technique. The acute success rate was 100% in the study population, and no complications occurred during the study period. Conclusion Ablation-index guided ZF PVI is feasible and safe. Using this technique, the procedure time can be shortened besides achieving a similar acute success rate without increasing complications.

Use of a novel, mode-switching electroanatomic mapping function and its effect on procedure and fluoroscopy duration in de novo AF procedures

Abstract Background Electroanatomical mapping systems utilize either an impedance-primary (IP) or magnetic-primary (MP) coordinate system for navigation. IP systems allow visualization of metal within the impedance field and can be scaled with supplemental magnetic information. MP systems collect information from catheters with a magnetic sensor, and supplementary impedance information is used to visualize catheters without a sensor. One commercially available mapping system offers both IP and MP navigation modes; however, operators must select a mode at procedure start. A novel software function allowing for near-instant transition between modes was recently introduced; its impact on procedural metrics has not yet been quantified. Objective Assess the impact of a mode-switching software function (MS) on acute procedural metrics in de novo paroxysmal atrial fibrillation (PAF) cases in which both the IP and MP modes were used, compared to procedures in which IP or MP was used alone. Methods Observational data was collected from 309 de novo PAF cases performed at 63 centers in Europe, the US, and Australia. Ablation technology used, procedure duration, fluoroscopy time, and acute outcomes were collected. Results Of 309 cases analyzed, 157 (50.8%) used MS, 97 (31.4%) used MP alone, and 55 (17.8%) used IP alone. Radiofrequency ablation (RFA) was used in 291 (94.2%) cases, while the remaining 18 (5.8%) used cryoablation. Irrigated, contact force sensing RFA catheters were used in 153 (97.4%) MS, 89 (91.8%) MP, and 29 (52.7%) IP cases. Mean procedure durations for MS and MP cases were similar: 106.2±51.6 min and 106.8±53.0 min, respectively (p=0.93). However, IP cases were significantly longer than both MS and MP cases, 134.2±53.8 min (p=0.002). Fluoroscopy time was significantly less in the MS group compared to MP and IP groups: 3.9±5.5, 6.1±5.2, and 7.8±6.4 min, respectively (p<0.001). No fluoroscopy was used in significantly more MS compared to MP or IP cases: 72 (45.9%) MS, 10 (10.3%) MP, and 8 (14.5%) IP cases (p<0.001). When these 90 cases were excluded, mean fluoroscopy times were similar between MS, MP, and IP cases (7.1±5.6, 6.8±5.0, and 9.2±5.9 min, respectively (p=0.05)). Acute success rates were not significantly different between modes: 98.6% MS, 100% MP, and 100% IP (p=0.49). Conclusions In this analysis of international usage of a novel software function, cases utilizing MS had significantly shorter fluoroscopy durations with similar acute success rates and procedure durations than those using MP or IP. When zero fluoroscopy cases were excluded, there was no significant difference in fluoroscopy times; however, there were significantly more zero fluoroscopy cases in the MS group, indicating that, while MS supports and may encourage low-fluoroscopy workflows, differences in procedural metrics seen may be biased by operator preference. Future analyses are warranted to provide insight into operator-specific metrics when using MS.Fluoroscopy Duration Comparison

Feasibility study of cryoballoon ablation for atrial fibrillation with KODEX-EPD: a single center experience

To evaluate the feasibility of cryoballoon (CB) ablation of atrial fibrillation (AF) under the guidance of a new three-dimensional (3D) mapping system KODEX-EPD. 40 patients scheduled for CB ablation of AF in the first affiliated Hospital of Xinjiang Medical University from August 2021 to July 2022 were randomly divided into two groups: KODEX-EPD 3D mapping system guidance group (KODEX group, n = 20) and conventional two-dimensional perspective group (standard group, n = 20). The ablation time, operation time, fluoroscopy time, fluoroscopy dose, contrast agent dosage and follow-up data were compared between the two groups. Besides, the feasibility and accuracy of the dielectric sensing system in evaluating pulmonary vein (PV) occlusion in patients with AF during CB ablation were verified. All pulmonary veins were being isolated. The ablation time (36.40 ± 6.72 min vs 35.15 ± 6.29 min, P > 0.05) and the operation time (64.20 ± 11.82 min vs 66.00 ± 13.18 min, P > 0.05) were not statistically different in the two groups. The standard group has longer fluoroscopy time, dose and contrast medium dosage. There were significant differences in fluoroscopy time (532.30 ± 72.83 s vs 676.25 ± 269.33 s, P < 0.05), fluoroscopy dose (110.00 ± 28.64 mGy vs 144.68 ± 66.66 mGy, P < 0.05), and contrast medium dosage (71.90 ± 5.97 ml vs 76.05 ± 5.93 ml, P < 0.05) between the two groups. The learning curves of the first 5 patients and the last 15 patients in the KODEX group were compared. There was no statistical difference in the ablation time (36.80 ± 8.56 min vs 36.27 ± 6.34 min, P > 0.05) or the operation time (69.00 ± 5.00 min vs 62.60 ± 13.10 min, P > 0.05); however, compared to the first 5 patients, fluoroscopy time (587.40 ± 38.34 s vs 513.93 ± 73.02 s, P < 0.05), fluoroscopy dose (147.85 ± 35.19 mGy vs 97.39 ± 8.80 mGy, P < 0.05) and contrast medium dosage (79.60 ± 1.14 ml vs 69.33 ± 4.45 ml, P < 0.05) were significantly decreased. Using pulmonary venography as the gold standard, the sensitivity, specificity of the completely occlusion in KODEX group was 93.6% (95% CI 85–97.6%) and 69.6% (95% CI 54–81.8%); and the sensitivity, specificity of the small leak in KODEX group was 93.1% (95% CI 82.4–97.8%) and 82.0% (95% CI 65.9–91.9%). During an average follow-up of (9.90 ± 1.06) months, there was no statistical difference in arrhythmia recurrence and antiarrhythmic drugs taking after CB ablation between the two groups (P > 0.05). Using the KODEX-EPD system, the CB ablation procedure can correctly evaluate the PV occlusion, and significantly reduce fluoroscopy exposure and contrast medium without significantly increasing the operation time.

Radiation exposure during distal and traditional radial coronary angiography and percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

Previous studies show that the distal transradial approach (dTRA) is safe and effective for coronary angiography and percutaneous coronary intervention. However, the effect of dTRA on radiation exposure in the catheterization laboratory has not been characterized. The authors analyzed the available literature to compare the radiation exposure associated with dTRA vs the traditional radial approach (TRA). A systematic review and meta-analysis of the scientific literature was conducted by using relevant terms to search the PubMed, Embase, and Cochrane Library databases from their inception until October 13, 2022, to identify randomized controlled trials (RCTs) comparing dTRA with TRA. The primary outcome was radiation exposure reported as fluoroscopy time, air kerma, or kerma-dose product. The standard mean difference (SMD) and its 95% confidence interval were used to summarize continuous variables. Random effect and meta-regression also were used for analyses. Among 484 studies identified, 7 were RCTs, with a total of 3427 patients (1712 dTRA, 1715 TRA). No difference was found between dTRA and TRA in radiation exposure quantified as fluoroscopy time (SMD -0.10 [-0.36, 0.15], P=.43) or air kerma (SMD -0.31 [-0.74, 0.13], P=.17). The overall estimate favored lower kerma-area product in the TRA (SMD 0.19 [0.08, 0.30], P=.0006). Meta-regression showed no correlation between fluoroscopy time and year of publication. Compared with TRA, dTRA was associated with significantly greater radiation exposure per the kerma-area product during interventional cardiology procedures, with no differences in fluoroscopy time and air kerma.

Radiation Exposure Using Rampart vs Standard Lead Aprons and Shields During Invasive Cardiovascular Procedures

BackgroundRadiation exposure during invasive cardiovascular procedures remains an important health care issue. Lead aprons and shields (LAS) are used to decrease radiation exposure but leave large portions of the body unshielded. The Rampart IC M1128 is a portable radiation shielding system that may significantly attenuate radiation exposure. MethodsCatheterization laboratory teams were randomized in a 1:1 fashion to perform elective invasive cardiovascular procedures utilizing either traditional LAS or the Rampart IC M1128. Radiation exposure was measured using real-time dosimetry monitoring in prespecified anatomic locations on 3 operators (position 1: first operator/fellow; position 2: second operator/attending; and position 3: catheterization laboratory nurse/technologist). Radiation exposure was measured on a per-case basis. ResultsIn total, 100 consecutive cases were randomized in this study (47 Rampart; 53 LAS). There was no difference in fluoroscopy time (12.3 minutes for Rampart vs 15.4 minutes for LAS; P = .52), dose area product (288 Gy⋅cm2 for Rampart vs 376.5 Gy⋅cm2 for LAS; P = .52), or scatter radiation (38.8 mRem for Rampart vs 46.8 mRem for LAS; P = .61) between the groups. There was significantly lower total body radiation (in milliroentgen equivalent man) exposure using the Rampart than that using LAS for each team member: position 1—0.1 mRem for Rampart vs 2.2 mRem for LAS; P < .001; position 2—0.1 mRem Rampart vs 3.2 mRem LAS; P < .001; and position 3—0.0 mRem for Rampart vs 0.8 mRem for LAS; P < .001. ConclusionsDuring routine clinical procedures, the Rampart system significantly decreases total body radiation exposure compared with traditional LAS.

Indirect Puncture Using a Novel Arc Puncture-Guided Device in Percutaneous Transforaminal Puncture on Goat Lumbar Spine Specimens

To investigate the implication of indirect puncture using a novel arc puncture-guided device in percutaneous transforaminal puncture in improving the puncture accuracy, reducing fluoroscopy times, puncture times and operation time. We have designed a novel arc puncture-guided device which consists of a 90°arc block and a 30°arc block. Punctures were performed on 8 fresh goat lumbar spine specimens. A senior doctor performed indirect punctures on the left side of L2/L3, L3/L4 and L4/L5 level side using the novel device (group A)，and on the right side of L2/L3, L3/L4 and L4/L5 level with conventional method (group B). We recorded the fluoroscopy times, puncture times and operation time. In group A, the first puncture could successfully reach the target after 1-3 punctures, and the one-time success rate of the second needle puncture is 91.67%. The total fluoroscopy times were 14.88±0.99 in group A and 16.08±2.22 in group B (p=0.027). The puncture times were 3.00±0.66 in group A and 6.04±2.13 in group B (P < 0.01). The operation time(s) was 273.75±30.19 in group A and 361.25±69.57 in group B (P < 0.01). There were significant differences in fluoroscopy times，puncture times and operation time between the two groups(P < 0.05). The indirect puncture using the novel arc puncture-guided device in percutaneous transforaminal puncture can significantly improve the puncture accuracy, reduce fluoroscopy times, puncture times and operation time. Indirect puncture using the novel device in percutaneous transforaminal endoscopic discectomy (PTED) is a potential and practical puncture method.

Clinical significance of the DUS4ABL strategy for systematically guiding left atrial and ventricular electrophysiological procedures

Abstract Funding Acknowledgements Type of funding sources: None. Background The ultrasound evolved as an indispensable tool to guide electrophysiological (EP) procedures (i.e., gain femoral access, transseptal puncture or exclude pericardial effusion). However, there are no data regarding the course and safety features of ablation procedures in a systematic ultrasound-guided approach. Purpose The aim of this study was to investigate if the systematic use of ultrasound in the course of all ablation procedures with transseptal punction benefits the outcome especially reducing major complication rates and benefitting the process with a reduction of procedure time and fluoroscopy time and dose. This approach consisted of for elements: Firstly the transesophageal echocardiography ruling out left atrial thrombi in the EP laboratory, secondly the ultrasound guided femoral vein puncture, thirdly the transesophageal guided transseptal punction (TSP) and fourthly ruling out pericardial effusion peri and post procedural (TTE), summarized as the DUS4ABL strategy. Methods A cohort of 222 patients undergoing LA or LV electrophysiological ablation guided by the DUS4ABL strategy were compared to a historical cohort of 299 undergoing the same type of procedure using only TTE post procedural to rule out pericardial effusion and in some cases having ruled out left atrial thrombi via TEE in an independent examination up to 7 days prior to the electrophysiological procedure. In the standard group the femoral access was performed by palpation only, the transseptal punction was managed pressure and fluoroscopy guided. Comorbidities, medication and epidemiological data were recorded and analyzed such as major complications specifically: Pericardiac tamponade, strokes, pseudoaneurysms of the femoral vein and artery, atrio-esophageal fistula, phrenic lesions and death. Results All 521 patients (43% female) were included into the final analysis: 43.8% of patients presented with paroxysmal atrial fibrillation, 35.3% had persistent atrial fibrillation, 10.9% had atrial tachycardia and 10% arrhythmias arising from the left ventricle. Baseline characteristics of the patients did not differ significantly between both groups. Results show a significantly lower complication rate in the DUS4ABL group compared to the standard group with 0 major complications occurring in the DUS4ABL group and 11 complications in the standard group (p=.001). Complications included 4 pericardial tamponades and 7 pseudoaneurysms of the femoral artery, all of which were successfully managed. Other complications such as strokes, phrenic lesions and death did not occur in either of the groups. There was no significant difference in procedure time between the groups but a significant difference in fluoroscopy time and dose both of which were significantly lower in the DUS4ABL group (p=0.002 and p=0.013). Conclusion The DUS4ABL strategy significantly reduced the overall complication rate, and also resulted in positive effects for fluoroscopy time and dose.

Pulsed field versus cryoballoon ablation of atrial fibrillation: A comparison of efficacy and safety in a 400 patient cohort

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Boris Schmidt, KR Julian Chun and Stefano Bordignon received speaking honoraria from Medtronic and Boston Scientific Background The cryoballoon (CB) is one of the most commonly used single shot devices for pulmonary vein isolation in patients with atrial fibrillation (AF). Pulsed field ablation (PFA) is a new non-thermal, tissue selective approach for pulmonary vein isolation. Purpose We sought to compare procedural safety and efficacy of these single shot ablation techniques. Methods Consecutive AF patients (paroxysmal / persistent AF) who underwent CB based pulmonary vein isolation (PVI) between November 2020 and February 2022 were enrolled and compared with patients who underwent PFA ablation in the same time period. Patients that underwent ablation beyond PVI (except for cavo-tricuspid isthmus ablation) were excluded. CB PVI was performed using the second-generation CB (CB 28 mm) with 240 sec based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) &amp;gt;75 sec. PFA was performed using the Farawave catheter, using the 31 or 35 mm device. All procedures were performed under deep sedation. Results Data from 400 consecutive patients were collected. Most baseline characteristics like age (CB: 67,5 ± 15,3; PFA: 68,4 ± 11; p=0,49), BMI (CB: 28,6 ± 6,3; PFA: 27,9 ± 5,6; p=0,27) and gender (male) (CB: 54%; PFA: 59%; p=0,31) were comparable between the two groups. All PVIs were successfully completed. In 98% (196) of patients in the CB group and 100% (200) in the PFA group, PVI was performed using solely CB or PFA respectively, meaning additional touch up ablation was only needed in 4 CB patients (2%; p=0,044) and 4 veins. Procedure time was significantly shorter in the PFA group (CB: 53 ± 15,3 minutes; PFA: 36,8 ± 13,5 minutes; p&amp;lt;0,001), whereas no difference in fluoroscopy time (CB: 8,1 ± 4,4 minutes; PFA: 7,8 ± 3,3 minutes; p=0,2) was observed. The rate of concomitant CTI-ablation was equal in both groups (CB: 1,5%; PFA: 1,5%; p=1,0). Complication rate was 3,5% with PFA and 6,5% in CB (p=0,17), a difference mostly driven by persistent phrenic nerve palsies (CB: 1,5%; PFA: 0%; p=0,08). All patients are out of the blanking period. There were 80 recurrences in blanking time (CB: 41; PFA: 39; p=0,8). In CB 19,5% of blanking time recurrences were atrial tachycardias compared to 35,9% in PFA (p=0,1). The average time to blanking recurrence was 14,1 ± 21,5 days in CB and 20,5 ± 23,2 in PFA (p=0,2). In total, there were 7 repeat procedures (4 in CB and 3 in PFA; p=0,7) during blanking time due to arrhythmias, despite of antiarrhythmic drugs and/or cardioversion. At the time of this analysis, the first hundred patients in each group reached one-year follow-up. Recurrence free survival after one year for patients with PAF was 82,6% in CB and 80,0% in PFA. In patients with persistent AF it was 70,8% in CB and 67,8% in PFA. Conclusion Cryoballoon and pulsed field ablation are both highly effective and safe techniques for PVI. PFA had a shorter procedure time, whereas the one year follow up was similar for both techniques.

Management of Femoral Shaft Fractures: The Significance of Traction or Operative Position.

Background and objective Intramedullary femoral nailing (IMN) is the gold standard for managing femoral shaft fractures (FSFs). Though good clinical outcomes and union rates have been reported following this procedure, it has also been commonly associated with perioperative complications. Positioning the patient in lateral decubitus, avoiding a fracture table, or using manual traction have been touted as possible techniques to reduce perioperative complications in IMN. However, given the scarce availability of comparative research, the decision to employ any of the techniques mentioned above is often guided by surgeon preference alone. In light of this, the purpose of this study was to determine whether the use of free-leg draping using either supine or direct lateral positioning with manual tractionreduces perioperative complications among trauma patients undergoing an anterograde femoral nailing surgery when compared to using a fracture table. Methods Consecutive adult patients from a level-one trauma center undergoing unilateral antegrade femoral fixation surgeries between 2016 and 2020 were retrospectively evaluated for possible inclusion in the study. Relevant perioperative and postoperative data, including length of hospital or ICU stay and perioperative complications, were included in the analysis. This study received research ethics board approval before data collection began. Results A total of 91 patients were ultimately included in the final analysis: 61 patients were included in thefree-legdraping with manual traction group (FL) and 30 patients were included in the traction table group (TT). Patients in the FL group had a similar operative and fluoroscopy time, blood loss, length of stay, and time on the ventilator. Subgroup analysis comparing positioning within the FL group revealed non-significant differences in fluoroscopy time(p=0.59)and lengthof stay (p=0.20) between the lateral and supine groups. Moreover, no differences in operative time, blood loss, and time on the ventilator were observed between lateral and supine groups. Conclusion Based on our findings, there were no significant differences in terms of operative or fluoroscopy time, perioperative complications, or length of time in the hospital or on the ventilator between the groups. Our study was limited by its small sample size and incomplete data. Further prospective randomized research is required to reach definitive conclusions on the appropriate manner to treat patients with these complex and morbid injuries.

Patient and provider radiation exposure during fluoroscopy guided chemical and thermal neurolysis of genicular nerves: A prospective cohort comparison study

PurposeTo evaluate the differences in radiation dosimetry, fluoroscopy time and procedure time between fluoroscopy-guided chemical and thermal genicular neurolysis techniques. MethodsThis single-site, open label observational cohort was done at an urban, tertiary medical center pain clinic. Board certified pain medicine physicians with at least 5 years of experience with genicular neurolysis procedures performed or supervised all interventions. Clinical characteristics and procedural details were collected at each procedure. Patients underwent chemical neurolysis using phenol or cooled radiofrequency neurolysis. Radiation dosimetry was the primary outcome and was compared between the between chemical and radiofrequency neurolysis groups. ResultsThirty-one subjects (15 had chemical and 16 had radiofrequency neurolysis procedures) underwent a total of 43 interventions. Twelve underwent bilateral procedures. Radiation dosimetry per procedure was 1.66 (0.89 to 2.45) Gy-cm2 for chemical and 1.76 (1.08 to 2.28) Gy-cm2 for radiofrequency neurolysis, adjusted mean difference −0.092 (−0.60 to 1.114, P ​= ​0.864) Gy-cm2. Procedure times were shorter for chemical compared to radiofrequency neurolysis procedures, difference 9.2 (95% CI 6.8 to 11.6, P ​< ​0.001) minutes; but no between treatment group differences in fluoroscopy time or interventionalist radiation exposure were observed. Higher BMI and advanced Kellgren-Lawrence grades were associated with increased patient radiation dosimetry. ConclusionsWe found that patient radiation dose, fluoroscopy time, and interventionalist radiation exposure were not different between chemical and radiofrequency neurolysis. Genicular neurolysis was more rapidly performed using chemical as compared to radiofrequency neurolysis. BMI and Kellgren-Lawrence grade, but not procedural factors were associated with greater absorbed radiation doses.

Which is the best way for patients with ureteral obstruction? Percutaneous nephrostomy versus double J stenting.

Percutaneous nephrostomy (PCN) and Double J stenting (DJS) are the 2 main treatment options of ureteral obstruction. We evaluate which of these 2 methods is superior concerning the course of procedure, postoperative complication and quality of life. A detailed review of electronic databases including PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure up to February 21st, 2021 was searched. Continuous data were evaluated using mean difference (MD) with 95% confidence interval (CI), while nominal data were analyzed by risk ratio (RR) with 95% CI. Meanwhile, we performed the subgroup analysis based on study design, disease type, sample size, sepsis, DJ diameter, nephrostomy diameter, anesthesia type and guidance under X-ray or ultrasound. There were 18 previous studies included in current study. As a result, we found that there were significant differences in fluoroscopy time (MD = 0.31; 95% CI, 0.14-0.48, P < .001) and hospital stay (MD = 1.23; 95% CI, 0.60-1.85, P < .001). However, no statistic difference was detected in operative time (MD = 5.40; 95% CI, -1.78 to 12.58, P = .140) between the paired groups. Although DJS showed a higher rate of postoperative complications (25.19% vs 17.61%), there was no significant difference in the incidence of complications following DJS and PCN (RR = 0.92; 95% CI, 0.60-1.43; P = .720). Based on the EuroQol analysis, the 2 main treatment options had different impacts on quality of life. The pooled results showed that PCN patients reported more difficulties in self-care compared to DJS patients (RR = 3.07; 95% CI, 1.32-7.14; P = .009). DJS is a safe and better method of temporary urinary diversion than PCN for management of ureteral obstruction with shorter fluoroscopy time and hospital stay. As for quality of life, patients receiving PCN had a distinct difficulty in self-care compared to those receiving DJS. However, these 2 treatment options often depends on the individual situation.

Comparison of cryoballoon and radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta-analysis.

There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF. A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects. One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I2 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I2 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I2 0%). Shorter procedure times were observed with CB (mean reduction 43.77min, 95% CI 66.45 to 21.09min, I2 96%) with no difference in fluoroscopy time (mean difference 0.82min, 95% CI - 11.92 to 13.55min, I2 100%). In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.

Initial Safety and Feasibility of Steerable Ureteroscopic Renal Evacuation: A Novel Approach for the Treatment of Urolithiasis.

Background:There is a need to reliably render urolithiasis patients completely stone free with minimal morbidity. We report on the initial safety and feasibility with steerable ureteroscopic renal evacuation (SURE) in a prospective study using basket extraction as a comparison.Materials and Methods:A pilot randomized controlled study was conducted comparing SURE with basket extraction postlaser lithotripsy. SURE is performed using the CVAC™ Aspiration System, a steerable catheter (with introducer). The safety and feasibility of steering CVAC throughout the collecting system under fluoroscopy and aspirating stone fragments as it was designed to do were evaluated. Fluoroscopy time, change in hemoglobin, adverse events through 30 days, total and proportion of stone volume removed at 1 day, intraoperative stone removal rate, and stone-free rate (SFR) at 30 days through CT were compared.Results:Seventeen patients were treated (n = 9 SURE, n = 8 Basket). Baseline demographics and stone parameters were not significantly different between groups. One adverse event occurred in each group (self-limiting ileus for SURE and urinary tract infection for Basket). No mucosal injury and no contrast extravasation were observed in either group. The CVAC catheter was steered throughout the collecting system and aspirated fragments. There was no significant difference in fluoroscopy time, procedure time, change in hemoglobin, or stone removal rate between groups. SURE removed more and a greater proportion of stone volume at day 1 vs baskets (202 mm3 vs 91 mm3, p < 0.01 and 84% vs 56%, p = 0.022). SURE achieved 100% SFR at 30 days vs 75% for baskets, although this difference was not statistically significant (p = 0.20).Conclusions:This initial study suggests SURE is safe, feasible, and may be more effective in stone removal postlaser lithotripsy compared to basketing. More development is needed, and larger clinical studies are underway.

Hybrid ablation procedure for the treatment of nonparoxysmal atrial fibrillation: A systematic review and meta-analysis.

Hybrid ablation combines the advantages of surgical and catheter ablation. Many studies have explored the efficiency and safety of hybrid ablation in patients with nonparoxysmal AF. We systematically searched for prospective controlled trials that compared hybrid ablation with catheter/surgical ablation in PubMed, Web of Science, Wiley Library, and CNKI. Our main assessment indicators included maintenance of sinus rhythm (SR) without antiarrhythmic drugs for more than 12 months, major adverse events (MAEs), procedure time and fluoroscopy time. Of 1214 identified studies, five were eligible and were included in our analysis (N=451 participants). The pooled results showed that hybrid ablation was more effective in maintaining SR than a single procedure (surgical ablation or catheter ablation) (OR=2.52, 95% confidence interval [CI]: 1.63-3.89, p<.001). Little significant heterogeneity was revealed (p=.32 for heterogeneity, I2 =14%). More MAEs occurred in the hybrid group than in the single procedure group (OR=7.47, 95% CI: 1.90-29.41, p=.004; I2 =0%). Two trials reported the procedure and fluoroscopy times, and the procedure time for hybrid ablation was significantly longer than that of a single procedure (mean difference=107.42, 95% CI: 88.62 to 126.22, p<.001; I2 =82%). There was no significant difference in fluoroscopy time between the 2 groups (mean difference=-1.00, 95% CI: -5.37 to 3.36, p=.65; I2 =12%). Hybrid ablation was more effective than catheter ablation and was as effective as surgical ablation in patients with nonparoxysmal AF. Meanwhile, hybrid ablation, especially concomitant hybrid ablation, increases the incidence of MAEs and prolongs the procedure time.

Does ERCP position matter? A randomized controlled trial comparing efficacy and complications of left lateral versus prone position (POSITION study).

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is traditionally performed with patients in the prone position (PP). However, this poses a potentially increased risk of anesthetic complications. An alternative is the left lateral (LL) decubitus position, which is commonly used for endoscopic procedures. Our aim was to compare cannulation rate, time, and outcomes in ERCP performed in LL versus PP. Patients and methods We conducted a non-inferiority, prospective, randomized control trial with 1:1 randomization to either LL or PP position. Patients > 18 years of age with native papillae requiring a therapeutic ERCP were recruited between March 2017 and November 2018 in a single tertiary center. Results A total of 253 patients were randomized; 132 to LL (52.2 %) and 121 to PP (47.8 %). Cannulation rates were 97.0 % in LL vs 99.2 % in PP (difference –2.2 % (one-sided 95 % CI: –5 % to 0.6 %). Median time to biliary cannulation was 03:50 minutes in LL vs 02:57 minutes in PP ( P = 0.62). Pancreatitis rates were 2.3 % in LL vs 5.8 % in PP ( P = 0.20). There were significantly lower radiation doses used in PP (0.23 mGy/m 2 in LL vs 0.16 mGy/m 2 in PP, P = 0.008) without a difference in fluoroscopy times. Conclusions Our analysis comparing LL to PP during ERCP shows comparable procedural and anesthetic outcomes, with significantly lower radiation exposure when performed in PP. We conclude that ERCP undertaken in the LL position is not inferior to PP, except for higher radiation exposure, and should be considered as a safe alternate position for patients undergoing ERCP.

Abstract 10829: Biradial Access Results in Lower Contrast Use and Fewer Complications Than Transfemoral Access in Alcohol Septal Ablation

Introduction: Transradial cardiac catheterization has equivalent efficacy, reduced vascular complications, and is more comfortable and convenient for patients than transfemoral catheterization. The biradial approach for alcohol septal ablation (ASA) has not been well studied. Since 2013, the biradial approach has become the standard approach for alcohol septal ablation at MUSC. This project tested the hypothesis that the biradial approach is equally efficacious and results in fewer complications than the transfemoral approach in ASA. Methods: In this study 274 consecutive patients were retrospectively analyzed from the MUSC alcohol septal ablation database (137= biradial approach, 137=femoral approach) and the changes in left ventricular outflow tract gradient (LVOTG), amount of contrast, fluoroscopy time, and complications were recorded. Groups were not significantly different in pre-ASA LVOTG (p=0.88 and 0.06 for resting and provoked LVOTG respectively). Results: The procedures were equally efficacious at reducing LVOTG with a mean reduction of resting LVOTG of 91.24% (SEM=1.21) in biradial access and 92.37% (SEM=1.14) in femoral access (p=0.5), and a mean reduction of provoked LVOTG of 80.31% (SEM=1.90) in biradial access and 82.17% (SEM=1.74) in femoral access (p=.47). The biradial approach was associated with significantly less contrast use than the femoral approach (mean of 98.1 ccs, SEM of 3.60, and 110.89 ccs, SEM of 4.84, respectively; p=.035). There were statistically significant differences in fluoroscopy time and incidence of complications between the procedures (fluoroscopy time mean of 17.42 min. (SEM=0.93) biradial and 13 min. (SEM=0.72) femoral; (p= 0.00028). Incidence of cardiac complications of .13 biradial and .23 femoral; (p= 0.04)). Conclusions: In this largest study to date, the transradial approach is equally efficacious and is associated with significantly lower contrast use, and fewer complications, albeit with increased fluoroscopy time, than the transfemoral approach in ASA.

Use of a 2 Dimensional Vessel Navigator Roadmap Decreases Patient Radiation Dose Compared to Standard 3D Mapping for Fenestrated Endovascular Aneurysm Repair

For fenestrated endovascular aneurysm repair (FEVAR), the implementation of the VesselNavigator (Philips Healthcare, Best, The Netherlands) to provide a 3-dimensional vessel roadmap has been shown to reduce patient radiation exposure. Unfortunately, FEVAR radiation doses remain substantial despite utilization of this technology. Traditionally, registration of the live fluoroscopy with the pre-operative CTA is performed via the acquisition of a low-dose cone-beam CT scan. However, this registration can also be accomplished with the acquisition of 2D X-rays using the c-arm in 2 different projection angles. We hypothesized that the 2D image acquisition for vessel roadmap development would result in a significant reduction in patient radiation dose in comparison to the 3D CT registration without compromising image quality or increasing procedural length. This single-center, retrospective study included FEVARs performed from January 2015 to May 2019. For patient data, the cumulative reference air kerma (RAK) was presented as geometric mean and standard deviation. A general linear model with log-normal distribution was used to test the difference in patient RAK between 2D X-ray and 3D CT VesselNavigator registration after adjusting for BMI and the number of vessel fenestrations (1 to 2 vs. 3 to 4). Fluoroscopy time was recorded and used as a surrogate for case complexity. All analyses were done in SAS 9.4 (SAS Institute, Inc., Cary, North Carolina). One hundred and sixty four FEVARs were performed on a Philips Allura Xper FD 20 fluoroscopy system equipped with clarity technology. The VesselNavigator registration was completed using 3D CT mapping in 99 cases and 2D X-rays in 65 procedures. On average, utilization of 2D mapping versus 3D mapping for the VesselNavigator resulted in a 20.4% reduction in patient RAK after controlling for BMI and number of vessel fenestrations, P = 0.0135. There was no significant difference in fluoroscopy time between the 2 study groups (P= 0.81) suggesting that image quality was not compromised by the use of 2D mapping leading to the need for additional fluoroscopy. Acquisition of 2D films rather than a 3D CT scan for VesselNavigator registration allows for a significant reduction in patient radiation dose during FEVAR without increasing the case complexity or compromising image quality.

Shifting Spine Interventional Pain Injections From the Hospital to a Clinic Setting: Increased Efficiency and Decreased Health System Costs.

Spine interventional pain injections have dramatically increased in volume in the past three decades. High referral volumes at our institution necessitated using both a hospital-based interventional suite and a clinic-based suite scheduled on a first-come, first-served basis. We sought to determine whether the clinic-based suite provided benefits in efficiency and health system cost in comparison with the hospital suite without compromising quality of care. To investigate differences between outpatient procedures performed in hospital-based procedure rooms (HBPRs) and clinic-based procedure rooms (CBPRs), we reviewed all consecutive outpatient spine interventional pain procedures performed by the interventional neuroradiology service over a 12-month period. We analyzed procedure complexity, fluoroscopic times, procedural times, patient wait times, and health system costs for each case, as well as any complications. Our analysis demonstrated similar procedural complexity between sites with decreased average fluoroscopic time (112 seconds versus 163 seconds, P= .002), procedural time (17 min versus 28 min, P < .001), and wait time (20 min versus 38 min, P < .001) in the CBPR versus the HBPR. In cases without trainee involvement, procedural and wait times were decreased (P < .001, P= .008) with no difference in fluoroscopy time (P= .18). There were no complications at either site. The analysis of cost to the health system demonstrated that procedures in the HBPR cost >14 times the amount to perform than in the CBPR. Performing spine interventional pain procedures in a CBPR adds value by decreasing procedural, fluoroscopic, wait times, and health system cost compared with an HBPR without compromising safety.

MP22-10 COMPARISON OF FLUOROSCOPY TIME DURING URETEROSCOPY AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR RENAL STONES

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP22)1 Sep 2021MP22-10 COMPARISON OF FLUOROSCOPY TIME DURING URETEROSCOPY AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR RENAL STONES Mohamed Keheila, Akin Amasyali, Joshua Belle, Nikoli Brown, Jason Groegler, Joseph Hutton, Mohammad Hajiha, and D. Duane Baldwin Mohamed KeheilaMohamed Keheila More articles by this author , Akin AmasyaliAkin Amasyali More articles by this author , Joshua BelleJoshua Belle More articles by this author , Nikoli BrownNikoli Brown More articles by this author , Jason GroeglerJason Groegler More articles by this author , Joseph HuttonJoseph Hutton More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002013.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are minimal data comparing fluoroscopy time between ureteroscopy (URS) and extracorporeal shockwave lithotripsy (SWL). One prior study showed no difference in fluoroscopy time between the two modalities. Over time, techniques to reduce fluoroscopy during URS have evolved. The purpose of this study was to compare the outcomes and fluoroscopy times between URS and SWL for renal stones in modern practice. METHODS: Outcomes were retrospectively collected from 364 patients who underwent URS and 444 patients who underwent SWL for urolithiasis targeted using fluoroscopy in a single academic institution from July 2012 to February 2019. Patients with ureteral stones, renal stones <5 mm and >20 mm, and those who underwent both URS and SWL were excluded. After patient matching, 86 URS and 237 SWL patients were included for analysis. Mann-Whitney U and Chi-square tests were used to compare fluoroscopy time and clinical outcomes with p<0.05 considered significant. RESULTS: Gender distribution, age, BMI, stone size, and stone location were not different between patients. Total mean number of stones was higher in the URS group (2.4±1.4) compared to SWL group (1.5±0.9, p<0.05). Fluoroscopy time was greater in patients who underwent SWL (189.3±98.5 seconds) compared to those undergoing URS (6.7±11.9 seconds; p<0.05). Ureteroscopy had a significantly higher SFR compared to SWL (p<0.05). Both groups had similar complication rates (4.7 vs. 7.0%, p=0.32) and Clavien-Dindo scores. CONCLUSIONS: Our study demonstrates that in the modern era, SWL results in ∼27x increased radiation exposure compared to URS. In addition, this study agrees with prior findings demonstrating that URS has a higher stone free rate with a similar complication rate compared to SWL. This highlights the importance of developing strategies for reducing fluoroscopy time while performing SWL such as the use of ultrasound guidance. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e394-e394 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Keheila More articles by this author Akin Amasyali More articles by this author Joshua Belle More articles by this author Nikoli Brown More articles by this author Jason Groegler More articles by this author Joseph Hutton More articles by this author Mohammad Hajiha More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Loading ...