Fluoroscopy Research Articles

Feasibility study on atrial fibrillation ablation with pulsed field ablation and concomitant occlusion of the left atrial appendage.

Atrial fibrillation (AF) ablation and left atrial appendage occlusion (LAAO) are increasingly performed as individual procedures. Pulsed field ablation (PFA) has significantly reduced procedure duration and may be advantageous for the combined approach. We have launched a programme for simultaneous AF ablation using PFA and LAAO for patients qualifying for both treatments and excluding those with a complex anatomy. We compare procedure duration and fluoroscopy time against individual procedures (either AF ablation or LAAO alone), all performed by the same operators and using consistent technologies. We performed the combined procedure in 10 patients (50% males; median age 70 years) and excluded 2 patients (17%) because of a complex left atrial appendage anatomy. No death, stroke, or major bleeding events, including pericardial effusion, occurred. For single-procedure comparison, 207 AF ablation procedures and 61 LAAO procedures were available. The total median procedure duration was 79 min (range 60-125) for the combined procedure, 71 min (25-241) for individual AF ablation (51 min without and 78 min with 3-dimensional electroanatomic mapping), and 47 min (15-162) for individual LAAO. The respective fluoroscopy times were 21 (15-26), 15 (5-44), and 10 (3-50) min. For the combined procedure, femoral vein access to last PFA application lasted 49 min (34-93) and LAAO added 20 min (15-37). Simultaneous PFA-based AF ablation and LAAO in carefully selected patients is feasible and safe and can be executed within a short overall procedure duration.

GI and GU fluoroscopy in common post-op oncologic surgeries: what you need to know about this leaky business!

Over the past several years, there has been a trend of decreasing screening or diagnostic fluoroscopic examinations ordered by clinical teams, particularly double contrast gastrointestinal studies. The underlying reason is due to increasing number of endoscopic procedures performed by Gastroenterology and Urology and usage of other imaging modalities, which are either more sensitive and/or offer the ability to obtain tissue for confirmation. Many fluoroscopic studies are now tailored toward patients who have undergone gastrointestinal or genitourinary oncologic surgeries, providing both functional and anatomic information, which are important tools for patient management. Some of these surgeries are very complex and an understanding of the postoperative anatomy and potential pitfalls is important to accurately evaluate for complications. The purpose of this article is to describe techniques and indications for common post-operative fluoroscopic procedures in gastrointestinal and genitourinary oncology while reviewing normal appearances. Complications, with emphasis on postoperative leaks, will be highlighted. Familiarity with the various types of gastrointestinal surgeries and urinary diversion techniques and knowledge of the expected postsurgical appearance is essential for achieving an accurate and prompt diagnosis of complications to allow for adequate treatment and management.

Method for defining the horizontal plane in fluoroscopic kinematic analysis

PurposeIn vivo kinematics of skeletal joints and prostheses is affected by gravity; therefore, absolute tilt must be taken into account. However, current fluoroscopic kinematic analysis cannot measure the tilt. This study introduces and validates a method for defining the horizontal plane in fluoroscopy systems to measure the tilt of an object. MethodsA rectangular metal plate (200 ​× ​200 ​× ​10 ​mm) with a flatness of 0.03/100 ​mm was horizontally adjusted using a leveler (sensitivity of 0.02° and accuracy of ±0.06°), and its three-dimensional coordinate was calculated from a two-dimensional fluoroscopic image. A coordinate calculation formula was developed, with precision and accuracy assessed via computer simulations. Actual fluoroscopic tests included four aspects: accuracy under the same condition; accuracy under different X-ray tube height; reproducibility when changing X-ray tube height; and reproducibility when the flat panel was tilted and returned. ResultsThe theoretical measurement error indicated by the computer simulations was 0.0 ​± ​0.2° on the xy-plane and 0.0 ​± ​0.0° on the yz-plane. The actual experimental results showed that the horizontal plane tilt was measured to be −0.2 ​± ​0.1° tilt on the xy-plane and 0.3 ​± ​0.0° tilt on the yz-plane for the device used in this study. The F-test showed no significant differences between the computer simulations and the actual experiments. There were no significant differences between the four actual tests. ConclusionsThis method enables the horizontal plane to be defined and the tilt of an object to be measured in fluoroscopic kinematic analysis.

Use of Yolo Detection for 3D Pose Tracking of Cardiac Catheters Using Bi-Plane Fluoroscopy

The increasing rate of minimally invasive procedures and the growing prevalence of cardiovascular disease have led to a demand for higher-quality guidance systems for catheter tracking. Traditional methods for catheter tracking, such as detection based on single points and applying masking techniques, have been limited in their ability to provide accurate pose information. In this paper, we propose a novel deep learning-based method for catheter tracking and pose detection. Our method uses a Yolov5 bounding box neural network with postprocessing to perform landmark detection in four regions of the catheter: the tip, radio-opaque marker, bend, and entry point. This allows us to track the catheter’s position and orientation in real time, without the need for additional masking or segmentation techniques. We evaluated our method on a dataset of fluoroscopic images from two distinct datasets and achieved state-of-the-art results in terms of accuracy and robustness. Our model was able to detect all four landmark features (tip, marker, bend, and entry) used to generate a pose for a catheter with 0.285 ± 0.143 mm, 0.261 ± 0.138 mm, 0.424 ± 0.361 mm, and 0.235 ± 0.085 mm accuracy. We believe that our method has the potential to significantly improve the accuracy and efficiency of catheter tracking in medical procedures that utilize bi-plane fluoroscopy guidance.

Cardio-respiratory motion compensation for coronary roadmapping in fluoroscopic imaging.

Inferring the shape and position of coronary artery poses challenges when using fluoroscopic image guidance during percutaneous coronary intervention (PCI) procedure. Although angiography enables coronary artery visualization, the use of injected contrast agent raises concerns about radiation exposure and the risk of contrast-induced nephropathy. To address these issues, dynamic coronary roadmapping overlaid on fluoroscopic images can provide coronary visual feedback without contrast injection. This paper proposes a novel cardio-respiratory motion compensation method that utilizes cardiac state synchronization and catheter motion estimation to achieve coronary roadmapping in fluoroscopic images. For more accurate cardiac state synchronization, video frame interpolation is applied to increase the frame rate of the original limited angiographic images, resulting in higher framerate and more adequate roadmaps. The proposed method also incorporates a multi-length cross-correlation based adaptive electrocardiogram (ECG)matching to address irregular cardiac motion situation. Furthermore, a shape-constrained path searching method is proposed to extract catheter structure from both fluoroscopic and angiographic image. Then catheter motion is estimated using a cascaded matching approach with an outlier removal strategy, leading to a final corrected roadmap. Evaluation of the proposed method on clinical x-ray images demonstrates its effectiveness, achieving a 92.8% F1 score for catheter extraction on 589 fluoroscopic and angiographic images. Additionally, the method achieves a 5.6-pixel distance error of the coronary roadmap on 164 intraoperative fluoroscopic images. Overall, the proposed method achieves accurate coronary roadmapping in fluoroscopic images and shows potential to overlay accurate coronary roadmap on fluoroscopic image in assisting PCI.

Immobilization during infant fluoroscopy: Pros and cons

This article explores the practice of immobilization during fluoroscopy procedures for infants, discussing its advantages and disadvantages. The authors examine contrasting policies and thoughts on immobilization across different medical institutions. While some advocate for its routine use to minimize patient motion, enhance imaging quality, and decrease radiation exposure, others question its necessity and raise concerns about patient consent and parental distress. Ethical dilemmas are also discussed regarding patient autonomy and psychological impact on families. The authors advocate for a balanced approach, recognizing the utility of immobilization in certain clinical scenarios while still emphasizing patient-centered care. Ultimately, the article underscores the importance of institutional policies that prioritize both patient safety and ethical principles in pediatric radiology practices.

Procedural efficiency is enhanced combining the pentaspline pulsed field ablation catheter with three-dimensional electroanatomical mapping system for pulmonary vein isolation

Abstract Background Pulsed field ablation (PFA) offers a safe, non-thermal alternative for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Currently, the pentaspline PFA-system relies heavily on fluoroscopy for catheter manipulation, which poses challenges due to the complexity of left atrium anatomy. Incorporating three-dimensional electroanatomical mapping (3D-EAM) could improve procedural efficiency reducing dependency on fluoroscopy guidance. This study aims to evaluate the effects of integration of 3D-EAM with PFA during PVI. Methods Between September 2022 and December 2023, we retrospectively enrolled 248 patients with paroxysmal or persistent AF undergoing PVI at our center using the pentaspline PFA catheter. The control group (n = 104) received conventional PFA with fluoroscopic guidance alone, while the intervention group (n = 144) underwent PVI with PFA with 3D-EAM integration. Primary outcomes were procedural time, fluoroscopy time (FT), and dose area product (DAP). Secondary endpoints included acute procedural success and incidence of periprocedural complications. Results In the 3D-EAM-PFA group, procedural time was 63.3 ± 14.3 min, compared to 65.6 ± 14.9 min in the control group (p = 0.22). The 3D-EAM group experienced significantly reduced FT (9.7 ± 4.4 min vs. 16.7 ± 5.2 min) and DAP (119.2 ± 121.7 cGycm2 vs. 338.7 ± 229.9 cGycm2) compared to the control group, respectively (p < 0.001). Acute procedural success was achieved in all cases. No major complications were observed in either group. Conclusion Integration of 3D-EAM with the pentaspline PFA catheter for PVI in AF treatment offers a promising approach, with significantly reduced fluoroscopy exposure without compromising procedural time and efficacy. Graphical abstract

Evaluating Radiation Exposure to Oral Tissues in C-Arm Fluoroscopy A Dose Analysis

This study investigates the radiation dose to oral mucosal tissues during C-arm fluoroscopy imaging using an Alderson Rando phantom and thermoluminescent dosimeters (TLD-100) for precise measurements. The aim is to assess the potential risks for patients and healthcare personnel exposed to ionising radiation during these procedures. The Alderson Rando phantom, a human-equivalent model, was utilized to simulate radiation exposure in a controlled environment. TLD-100 dosimeters were strategically positioned in the 6th section of the phantom and exposed to radiation at intervals of 0.5, 1, 2, 4, and 8 minutes. The experiments were carried out at Hisar Hospital Intercontinental and the dosimeter readings were then evaluated at Çekmece Nuclear Research Centre. The study demonstrated that the mean radiation doses affecting the internal tissue of the oral mucosa were 0.912 mSv (0.5 minutes), 1.604 mSv (1 minute), 2.719 mSv (2 minutes), 6.763 mSv (4 minutes), and 13.811 mSv (8 minutes). The mean radiation doses affecting the lip skin tissue were 1.423 mSv (0.5 minutes), 2.435 mSv (1 minute), 5.2 mSv (2 minutes), 10.195 mSv (4 minutes), and 17.404 mSv (8 minutes). Results indicate a direct relationship between radiation dose and exposure time, with increasing doses observed at longer exposure times. This research aims to improve patient safety during C-arm scope imaging procedures by determining precise radiation dosage levels for oral mucosal tissues and addressing the lack of published reference values in the literature.

Adjunctive Dorsal Spanning Plate Fixation in the Stabilization of Perilunate Dislocations

To compare the biomechanical properties of adjunctive dorsal spanning plate (DSP) fixation with traditional K-wire fixation of perilunate dislocations in a cadaveric model. Fourteen fresh-frozen cadaveric wrists underwent simulated perilunate injury. The specimens were randomly allocated to either K-wire fixation versus K-wire and DSP fixation. Scapholunate (SL) ligament repair was performed in all specimens. The constructs were tested using a robot cyclically and to failure. Fluoroscopic images were obtained of the specimens prior to simulated injury, after fixation, after 10 and 100 loading cycles, and at construct failure. Differences in carpal alignment parameters (SL interval, SL angle, lunotriquetral interval, and capitolunate angle) and load to failure were recorded. There were no statistically significant differences between the two group's carpal alignment parameters after fixation. Specimens fixated with K-wires and DSP required significantly higher loads to achieve construct failure. The only significant difference between the two groups' carpal alignment parameters was SL interval change at failure. Compared with K-wire fixation alone, adjunctive DSP fixation resulted in significantly increased loads to failure and decreased change in SL interval at the time of failure. Adjunctive DSP may be a useful technique in the polytraumatized patient in whom providing back a weight-bearing extremity may be advantageous in the rehabilitation process.

Impact Of Introducing 3D Printing-Assisted Surgery Into Clinical Practice For Traumatic Pelvic And Acetabular Fractures

BackgroundGiven the novelty of three-dimensional (3D) printing-assisted fracture surgery in orthopaedics, surgeon familiarity is limited and learning curve is high. As such, it is unclear how the introduction of 3D printing into clinical practice for pelvic and acetabular fracture surgery would impact perioperative outcomes. The aim of this study was to determine the impact of introducing 3D printing-assisted surgery on perioperative outcomes for traumatic pelvic and acetabular fractures. MethodsWe retrospectively identified consecutive patients who underwent surgical fixation of traumatic pelvic and acetabular fractures from 2018 to 2022 at a single tertiary hospital. The patients included in the study were divided into two groups: (1) 3D printing-assisted surgery and (2) conventional surgery. Baseline demographics and perioperative outcomes of total surgical duration, estimated blood loss, blood transfusion, number fluoroscopy images, fluoroscopy duration and postoperative disposition were recorded and compared between the two groups. ResultsIn total, 26 patients were included in the present study, with 3D printing-assisted surgery being used in 34.6% (n=9) of cases. There were no significant differences in baseline demographics or fracture type between the 3D printing group and conventional group. As compared to patients who underwent conventional surgery, those that underwent 3D printing-assisted surgery had, on average, shorter surgical duration (299.8±88.2 vs 309.1±143.1 mins), lesser estimated blood loss (706.3±330.0 vs 800.0±584.2 ml), lower transfusion rates (50.0% vs 52.9%), lower number of intraoperative fluoroscopy images (62.8±74.5 vs 71.6±47.9 images) and shorter fluoroscopy duration (235.0±79.2 vs 242.3±83.5 mins), although statistical significance was not achieved. None of the patients in the present study developed surgical complications postoperatively. ConclusionThe introduction of 3D printing-assisted surgery in clinical practice for pelvic and acetabular fractures is a safe and viable adjunct in pelvic and acetabular surgery, achieving comparable perioperative outcomes in the initial phase.

Minimally Invasive Anterior Closing–wedge Osteotomy for Posterior Tibial Slope Correction: A Pilot Study

Introduction: The purpose of this study was to investigate the feasibility of performing a new minimally invasive technique for anterior closing–wedge high tibial osteotomy. Our hypothesis was that we would be able to successfully perform the minimally invasive osteotomy with consistent correction of the posterior tibial slope. Materials and Methods: Five lower limbs from cadaveric unidentified donors were obtained. Fluoroscopic imaging of the knee was obtained to determine the baseline tibial slope. A standard anterior closing–wedge osteotomy was planned to obtain the desired correction. The anterior bony segment was resected from the proximal tibia utilizing the Shannon burr under fluoroscopic guidance through a 2 cm medial incision. Fixation was completed with 2 staples positioned medial and lateral to the tibial tubercle. Results: The average posterior tibial slope of the 5 specimens was 8 degrees (SD: 2.3, range: 6 to 12). The average final posterior tibial was 1.8 degrees (SD: 2.1, range: −1 to 5). The average slope correction was 6.2 degrees (SD: 0.7, range: 5 to 7). Posterior tibial cortical fracture did not occur in any of the cases. Conclusions: Our novel minimally invasive anterior closing–wedge high tibial osteotomy technique resulted in a reproducible correction of posterior tibial slope in a cadaveric model. This is the first study to describe a minimally invasive technique for anterior closing–wedge high tibial osteotomy. Larger cadaveric studies including multiple surgeons across institutions are warranted to validate the described technique between providers. Level of Evidence: Level IV—Controlled laboratory study

CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient.

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

Optimal tibial tunnel angulation for anatomical anterior cruciate ligament reconstruction using transtibial technique

Numerous studies have suggested that the primary cause of failure in transtibial anterior cruciate ligament reconstruction (ACLR) is often attributed to non-anatomical placement of the bone tunnels, typically resulting from improper tibial guidance. We aimed to establish the optimal tibial tunnel angle for anatomical ACLR by adapting the transtibial (TT) technique. Additionally, we aimed to assess graft bending angle (GBA) and length changes during in vivo dynamic flexion of the knee.Twenty knee joints underwent a CT scan and dual fluoroscopic imaging system (DFIS) to reproduce relative knee position during dynamic flexion. For the single-legged lunge, subjects began in a natural standing position and flexed the right knee beyond 90° When performing the lunge task, the subject supported the body weight on the right leg, while the left leg was used to keep the balance. The tibial and femoral tunnels were established on each knee using a modified TT technique for single-bundle ACLR. The tibial tunnel angulation to the tibial axis and the sagittal plane were measured. Considering that ACL injuries tend to occur at low knee flexion angles, GBA and graft length were measured between 0° and 90° of flexion in this study.The tibial tunnel angulated the sagittal plane at 42.8° ± 3.4°, and angulated the tibial axis at 45.3° ± 5.1° The GBA was 0° at 90° flexion of the knee and increased substantially to 76.4 ± 5.5° at 0° flexion. The GBA significantly increased with the knee extending from 90° to 0° (p < 0.001). The ACL length was 30.2mm±3.0 mm at 0° flexion and decreased to 27.5mm ± 2.8 mm at 90° flexion (p = 0.072). To achieve anatomic single-bundle ACLR, the optimal tibial tunnel should be angulated at approximately 43° to the sagittal plane and approximately 45° to the tibial axis using the modified TT technique. What's more, anatomical TT ACLR resulted in comparable GBA and a relatively constant ACL length from 0° to 90° of flexion. These findings provide theoretical support for the clinical application and the promotion of the current modified TT technique with the assistance of a robot to achieve anatomical ACLR.

Radiation Dose Levels in Submandibular and Sublingual Gland Regions during C-Arm Scopy

The subject of this study is to determine the radiation dose exposure to the sublingual glands and submandibular glands during c-arm fluoroscopy imaging by measuring them with dosimeters (TLD-100). The results of this study will contribute to understanding the effects of radiation exposure on the human body. Data for the research was collected by measuring the radiation exposure at specific time intervals: 0.5, 1, 2, 4, and 8 minutes. Measurements were taken for three regions: right and left submandibular glands, and sublingual gland. The maximum radiation exposure for the right submandibular gland at 0.5, 1, 2, 4, and 8 seconds were 1294, 3119, 5916, 11925, and 21274 microSieverts (μSv) respectively. The maximum radiation exposure for the left submandibular gland at the same intervals were 877, 2104, 3704, 7816, and 14618 μSv respectively. For the sublingual gland, the maximum radiation exposure at these intervals were 958, 2081, 3815, 8332, and 14128 μSv respectively

Greater distance from the glenosphere center to the acromion reduces risk of acromial impingement in semi-inlay reverse shoulder arthroplasty

BackgroundRecently, the issue of subacromial notching, caused by acromial impingement has been reported. The purpose of this study was to assess the impact of differences in the distance between the glenosphere center and the greater tuberosity (DGT) and the distance between the glenosphere center and the acromion (DA) on the closest distance between the greater tuberosity and the acromion during active abduction in shoulders with reverse total shoulder arthroplasty (RSA). MethodsEleven shoulders with semi-inlay RSA were analyzed. Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional implant models at a mean of 16 months after surgery. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images (shape matching), and 3-dimensional kinematics of implants were computed. The closest distance between the acromion and greater tuberosity was computed at maximum abduction. DA and DGT were measured from 3-dimensional surface models. Shoulders were divided into two groups based on DA and DGT measurements and their closest distance data were compared between the groups. ResultsThere were 7 shoulders with DA ≥ DGT, and 4 shoulders with DA < DGT. Shoulders with DA ≥ DGT showed a significantly wider distance between the greater tuberosity and acromion at maximum abduction compared to those with DA < DGT (5.9 ± 2.4 mm vs. 0.6 ± 0.7 mm, respectively, P = 0.0021). There were no significant differences in maximum glenohumeral abduction angle and humeral abduction angle between the two groups. Although DA was significantly greater in shoulders with DA ≥ DGT than in those with DA < DGT (43.7 ± 4.4 mm vs. 35.1 ± 6.7 mm, respectively, P = 0.0275), there was no significant difference in DGT between the two groups. ConclusionsWhen DGT is less than DA in shoulders with RSA, the closest distance between the greater tuberosity and the acromion at maximum abduction is significantly wider compared to cases where DGT is greater than DA by 3-dimensional measurement. Therefore, acromial impingement is less likely to occur in shoulders with RSA when DA is greater than DGT. To avoid acromial impingement, it might be important to make DA greater than DGT.

Clinical Results and Safety of Intracardiac Echocardiography Guidance for Combined Catheter Ablation and Left Atrial Appendage Occlusion.

The goal of this study was to compare the procedural safety and long-term outcome associated with a combined catheter ablation and left atrial appendage occlusion (LAAO) procedure utilizing intracardiac echocardiography (ICE) guidance versus transesophageal echocardiography (TEE) guidance. The study focuses on implementing LAmbre and Watchman devices in patients diagnosed with nonvalvular atrial fibrillation (AF). A total of 363 patients diagnosed with nonvalvular AF and who underwent a combined procedure were prospectively enrolled between November 2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n = 132) and ICE group (n = 132) were systematically compared in terms of the combined procedure, imaging parameters, events related to the procedure, and subsequent outcomes during follow-up, including mortality, stroke, bleeding, device-related thrombus (DRT), and peri-device leaks (PDLs). The ICE group exhibited a significant reduction in total procedural duration (153.71 31.71 vs. 174.74 18.79 min), fluoroscopy radiation dosage (207.24 108.39 vs. 268.61 122.88 mGy), left atrial appendage occlusion procedure time (34.69 10.91 vs. 51.46 15.84 min), and contrast agent exposure (108.71 37.59 vs. 158.41 45.00 mL) compared to the TEE group. Angiography and ICE demonstrated a substantial correlation between the left atrial appendage (LAA) orifice and landing zone/LAA ostium (Pearson's correlation coefficient r = 0.808 and 0.536/0.697, two-tailed p 0.001). No occurrences of device-related embolism, thromboembolism, significant bleeding, or unexpected fatalities were observed in either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs. 0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after an average follow-up of 18.46 7.70 months in both groups, with no discernible differences. Multivariate logistic regression analysis identified a correlation between LAA velocity and the risk of PDL. The effectiveness and safety of ICE-guided combined treatment were demonstrated to be comparable to TEE guidance, accompanied by the additional advantages of decreased procedure time and fluoroscopy radiation exposure. NCT04391504, https://register.clinicaltrials.gov.

Pulmonary Vein Isolation with Pulsed Field Ablation and Size-Adjustable Cryo-Balloon: A Comparative Procedural Analysis of First-Time Use.

Background: Pulmonary vein isolation (PVI) is the standard of care for the treatment of symptomatic atrial fibrillation (AF). Novel techniques for PVI are the thermal size-adjustable cryo-balloon (CB) system and non-thermal pulsed field ablation (PFA) system. There are currently no data available for a direct comparison between these two systems. Furthermore, with new techniques, it is important to ensure a high level of efficiency and safety during treatment right from initial use. Therefore, the aim of this study was to directly compare the procedural data and safety of these two new PVI techniques in first-time users. Methods: We conducted a single-center prospective study involving 100 consecutive patients with symptomatic atrial fibrillation who underwent first-time PVI using either size-adjustable CB PVI or PFA PVI from July 2023 to March 2024. Results: Acute PVI was achieved in 100% of patients in both groups. First-pass isolation (FPI) was more frequently achieved in the PFA group compared to the size-adjustable CB group. The mean procedural duration and fluoroscopy dose were significantly shorter in the PFA cohort (p < 0.001). Furthermore, a significant reduction in fluoroscopy time was observed during the learning curve within the PFA group (p = 0.023). There were no major complications in both groups. Conclusions: Both systems demonstrate good effectiveness and safety during PVI performed by first-time users. However, the PFA group exhibited a significantly shorter procedural duration.

App-based analysis of the femoral tunnel position in ACL reconstruction using the quadrant method.

The purpose of this study was to examine the intra- and interobserver variability of an app-based analysis of the femoral tunnel position using the quadrant method in primary anterior cruciate ligament reconstruction. Between 12/2020 und 12/2021 50 patients who underwent primary anterior cruciate ligament reconstruction were included in this retrospective study. Intraoperative strictly lateral fluoroscopic images of the knee with marked femoral tunnel were analyzed by four observers using the quadrant method. For retest reliability analysis, measurements were repeated once by 2 observers after 4 weeks. The femoral tunnel position of all included patients averaged 27.86% in the depth relation and 15.61% in the height relation. Statistical analysis showed an almost perfect intra- and interobserver reliability in the depth and height relation. The ICC was 0.92 in the depth relation and 0.84 in the height relation. The Pearson's correlation coefficient in the depth and height relation of observer 1 (0.94/0.81) was only slightly different from the Pearson's correlation coefficient of observer 2 (0.92/0.85). The app-based tunnel analysis took on average 59 ± 16s per measurement. The femoral tunnel analysis with the app-based quadrant method has an almost perfect intra- and interobserver reliability. By smartphone camera, a fast and highly accurate, if necessary also intraoperative, control of the tunnel position can be performed. Level 3-diagnostic retrospective cohort study.

Implementation of near zero fluoroscopy in supraventricular tachycardia ablation procedures: a single center experience

Abstract Background Supraventricular tachycardia (SVT) are common cardiac arrhythmias, and catheter ablation has proven to be a very effective treatment, but exposes patients and healthcare providers to radiation. "Near Zero Fluoroscopy" (NZF) techniques, utilizing advanced imaging, aim to reduce radiation exposure while maintaining efficacy. Purpose To present an analysis of near-zero fluoroscopy in SVT ablation procedures, in a tertiary center, since its implementation. Methods We prospectively enrolled 446 SVT-diagnosed patients for this study. All of them underwent NZF procedures using the same specific 3D mapping system, between January/19 and December/22. Patients with atrial fibrillation or macroreentrant atrial tachycardias or when a different mapping system was used, were excluded. All patients provided informed consent. Results Our population had 266 (60%) females and a median age of 39 (IQR 24-51) years. AVNRT was the most frequent arrhythmia documented (229 cases, 51%), followed by Accessory Pathways (AP) (201 cases, 45%) and focal atrial tachycardia (AT) (16 cases, 4%). The ablation success rate was high (405/418, 97%). There was no ablation attempt in 12 patients (9 APs and 3 ATs) and the unsuccessful ablations (7/418 cases, 1,67%) were APs. Overall, fluoroscopy time was 1.1 minutes (IQR 0-2.6). There was no statistically significant difference in the distribution of fluoroscopy time among the types of SVT based on the Kruskal-Wallis test (p 0.14). Observing trends of fluoroscopy use through time, we acknowledge the presence of a learning curve, leading towards shorter times of X-ray during procedures along the first 3 years of implementation of a near-zero strategy. Median times (IQR) of fluoroscopy were as follows: 2019 – 2.25 (0.45-3.4) min; 2020 – 1 (0-2.5) min; 2021 – 0 (0-1.9) min; 2022 – 0.55 (03.05) min. (see BoxPlot) Pairwise comparisons using the Wilcoxon rank-sum test with continuity correction revealed statistically significant differences in medians between all pairs of years, with p-values adjusted for multiple comparisons using the Bonferroni method (p&amp;lt;0.01). In 2022, fluoroscopy time increased, when compared to 2021. We believe this finding can be explained by the fact that in 2022, our department received a new fellow and a young EP consultant (coming from a center where NZF was not the standard for SVT ablation), both being in the lab on a daily basis, explaining this upward trend in fluoroscopy time. There were no acute complications requiring hospital admission or active treatment. Conclusion Our results emphasize the potential of near-zero fluoroscopy techniques to enhance safety and reduce radiation exposure while maintaining a high level of procedural efficacy in the treatment of SVT cases. Absence of acute complications highlighted the safety of these approaches.

Automated template matching versus conventional pace-mapping during pvc ablation: results from a randomized controlled trial

Abstract Background Pace-mapping has an important role in the ablation of idiopathic premature ventricular contractions (PVC). There is a software with an automated algorithm annotating and visualizing template matching points. Automated template matching (ATM) facilitates the matching process and may thus shorten the procedure duration and potentially increase ablation success. In this randomized study we evaluate whether the use of the automated template matching (ATM) software compared to conventional pace-mapping (PM) influences outcomes and periprocedural parameters in patients undergoing PVC ablation. Methods The study was performed as a prospective randomized controlled single-center clinical trial. Patients scheduled for de-novo PVC ablation were included and randomly assigned to either PVC ablation using the ATM algorithm (ATM) or conventional pace-mapping (PM). The primary endpoint was the procedural outcome represented by the PVC burden after three and twelve months. Secondary endpoints were periprocedural parameters including procedure duration, number, and duration of radiofrequency application (RFA), fluoroscopy (FS) dose, and duration. An interim analysis was predetermined after 72 patients had completed their three-month follow-up. Results After the interim analysis, the study was prematurely ended for futility. At termination of the trial 108 patients had been included. 18 patients dropped out of the study. Out of the remaining 90 patients, 88 patients (97%) have completed the three-month follow-up, and 73 patients (81%) the twelve-month follow-up. The mean age at the time of procedure was 57.3 years [18-82] without significant differences between both groups. Before ablation, the mean PVC burden was 20.8% [0.1-55.0] (ATM: 20.8% [3.0-55.9]; PM: 20.7% [0.1-44.0]; p=0.959). At 3-month follow-up, the mean PVC burden in both groups (ATM: 4.7% [0-29.4]; PM: 3.6% [0-45.7]; p=0.512) showed no significant difference between the groups. At 12-month follow-up the mean PVC burden in both groups (ATM: 3.8% [0-31]; PM: 2.2% [0-25.6]; p=0.282) also resulted in a non-significant difference between the groups. Furthermore, the procedural parameters (table) did not differ significantly between both groups. Conclusion In this randomized trial, the use of the automated template matching software did not result in improved outcomes or procedure-related parameters. Conventional pace-mapping appeared to be equally effective compared to the automated template matching software as used in this study.Table secondary endpoints