Reduction In Fluoroscopy Time Research Articles

Clinical evidence of pacemaker implantation during gestation: a case series

Abstract Background Although recommended avoid any intervention during gestation in cases of poor tolerance to high degree atrioventricular block, pacemaker implantation may be necessary in pregnant women. Purpose To present outcomes of pacemaker implantation during gestation. Methods This prospective, single center study included 10 cases of pacemaker implantation during gestation (median age of patient - 26 years old at 18 weeks of gestation). We evaluated the further course of gestation and obstetric outcomes after implantation in comparison with pregnant with tachyarrythmias (n=111). Results Among 121 pregnant women with varying arrhythmias high degree atrioventricular block was detected in 10 cases (8,3%). In 6 cases this bradyarrhythmia diagnosed for the first time in gestation (60%). All pregnant with high degree atrioventricular block had clinical signs: dizziness and weakness (100%), syncope (70%), episodes of low blood pressure (100%). Pacemaker implantation performed due to hemodynamic instability and poor tolerance of bradyarrhythmia in all cases. Using electroanatomical mapping (Ensite Precision system)and echocardiographic guidance helped to reduce fluoroscopy time. For one pregnant implanted leadless pacemaker (Micra) with achieved more than 80% atrio-ventricular synchronization. Outcomes: further course of gestation characterized by increased incidence of uterine contractile activity (30%) in cases of high degree atrioventricular block, that was significantly higher than in pregnant with tachyarrhythmias (2%) (p=0.007). There were no differences in the rate of other complication: uterine blood flow violation (20% vs 12%, p=0.520), placental abraption (10% vs 5%, p=0.237) and preeclampsia (10% vs 5%, p=0.237). Vaginal type of delivery was in the majority of cases in both groups (70% vs 86%, p=0.553). Neonatal outcomes characterized with normal range of fetal birth weight (median 3163 vs 3212 grams, p=0.981) and 5 minute Apgar score (median 8.6 vs 8.7, p=0.564). There was no incidence of maternal and fetal mortality. In 12 month follow-up all patient have optimal electrical parameters of devise and remained stable over time. Conclusions High degree atrioventricular block in pregnant characterized by increased rate of uterine contractile activity. Pacemaker implantation during gestation can be effectively performed and associated with benign outcomes.

The efficacy of suprapatellar, parapatellar and infrapatellar intramedullary nailing in the treatment of tibial fractures: a systematic review and meta-analysis.

Tibial fractures are common and challenging orthopedic injuries that are commonly treated with intramedullary nailing techniques via suprapatellar (SP), parapatellar (PP), and infrapatellar (IP) approaches. This study aimed to provide a comprehensive comparative analysis of the efficacy of different treatment approaches based on clinical outcomes. We conducted a detailed search in PubMed, Cochrane Library, Embase, and Web of Science for clinical studies comparing suprapatellar, parapatellar, and infrapatellar approaches in intramedullary nailing of tibial fractures. Inclusion criteria included randomized controlled trials and retrospective cohort studies involving patients aged 18 and older, comparing outcomes of these surgical techniques. Exclusion criteria included studies with insufficient data, non-English publications, and those focusing on non-tibial fractures. A total of 15 studies involving 1396 patients were included in meta-analysis. Pooled results indicated that, compared to IP nailing, the SP approach significantly reduced fluoroscopy time (MD = -35.63, 95% CI -39.37 to -31.89, p < 0.001), operative time (MD = -10.72, 95% CI -17.30 to -4.15, p = 0.001), pain scores (SMD = -1.49, 95% CI -2.36 to -0.62, p < 0.001), and improved Lysholm scores (MD = 5.74, 95% CI 3.29 to 8.19, p < 0.001) and malalignment rate (RR = 0.24, 95% CI 0.08 to 0.68, p = 0.008). Quality of life assessments also indicated higher physical component scores for the SP group (MD = 6.68, 95% CI 5.19 to 8.17, p < 0.001). The SP approach provides significant intraoperative and postoperative benefits, reducing surgery time and improving patient outcomes in pain management and knee joint function. These findings support the SP approach as a preferred option for surgical treatment of tibial fractures.

A Revolutionary Device for Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Pilot Study

Background Endovascular repair for abdominal aortic aneurysms (AAA) has been the gold standard since it was established in 1991. Various graft configurations have been developed to overcome the limitations of endovascular aortic repair (EVAR), including contralateral gate cannulation (CGC). We propose a new device and technique intended to simplify endovascular AAA repair, along with reports of its application in six patients. Intervention The Taofan and Kang (T&amp;K) bidirectional endovascular aortic repair (B-EVAR (B-EVAR) device uses a main-body stent graft, two-limb extensions, and bare metal stent. The procedure involved accessing the right and left femoral arteries, followed by standard aortography evaluation using a pigtail catheter through the contralateral femoral access. The main body stent graft is deployed through ipsilateral femoral access using a balloon catheter, while the contralateral gate is cannulated with a hydrophilic coated wire. Both balloons were inflated simultaneously to ensure that the wires were in different lumens. Contralateral and ipsilateral extensions were deployed using a limb extension stent graft. Standard aortography evaluation was repeated. Result T&amp;K B-EVAR pilot procedures proved successful in various cases, from simple to complex anatomy, and even with varied graft stent deployment strategies. None of the patients had complications or prolonged length of stay (LOS). Follow-up CT did not reveal any high-pressure endoleaks. Conclusion T&amp;K B-EVAR has been proven to simplify endovascular AAA repair in six patients with excellent results. It is also reproducible, potentially universally applicable, and can offer operators ease of use, faster procedure times, reduced fluoroscopy times, and reduced contrast usage.

Comparison of Conventionally Performed and Intracardiac Echocardiography Guided Catheter Ablation of Atrioventricular Node in Patients with Permanent Atrial Fibrillation-A Retrospective Single-Center Study.

Background: Atrioventricular node (AVN) ablation is an effective treatment for atrial fibrillation (AF) with uncontrolled ventricular rates despite maximal pharmacological treatment. Intracardiac echocardiography (ICE) can help with visualizing structures, positioning catheters, and guiding the ablation procedure. We compared only fluoroscopy-guided and ICE-guided AVN ablation regarding patients with permanent AF. Methods: Sixty-two consecutive patients underwent AVN ablation were enrolled in our retrospective single-center study (ICE group: 28 patients, Standard group: 34 patients). Procedural data, acute and long-term success rate, and complications were analyzed. Results: ICE guidance for AVN ablation significantly reduced fluoroscopy time (0.30 [0.06; 0.85] min vs. 7.95 [3.23; 6.59] min, p < 0.01), first-to-last ablation time (4 [2; 16.3] min vs. 26.5 [2.3; 72.5] min, p = 0.02), and in-procedure time (40 [34; 55] min vs. 60 [45; 110], p = 0.02). There was no difference in either the total ablation time (199 [91; 436] s vs. 294 [110; 659] s, p = 0.22) or in total ablation energy (8272 [4004; 14,651] J vs. 6065 [2708; 16,406] J, p = 0.28). The acute success rate was similar (ICE: 100% vs. Standard: 94%, p = 0.49) between the groups. Conclusions: In our retrospective trial, ICE-guided AVN ablation reduced fluoroscopy time, procedure time, and first-to-last ablation time. There was no difference in ablation time, total ablation energy, acute and long-term success, and complication rate.

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.

Optimizing outcomes in catheter ablation for typical atrial flutter: a comparative study of intracardiac echocardiography versus fluoroscopy guidance

Abstract Background Catheter ablation is a standard intervention for typical atrial flutters, specifically targeting the cavotricuspidal isthmus (CTI). Intracardiac echocardiography (ICE) plays a pivotal role in providing real-time visualization of anatomical structures during the electrophysiology procedure, thereby enhancing safety and potentially reducing reliance on fluoroscopy, leading to improved procedural outcomes. We aimed to conduct a comparative analysis of procedural and follow-up outcomes between ICE-guided and fluoroscopy-only guided catheter ablations for CTI in patients undergoing treatment for typical atrial flutter. Methods A retrospective analysis was conducted at our university center, encompassing 376 consecutive patients in a single-center study. Of these, 158 underwent procedures guided solely by fluoroscopy, while 218 received ICE-guided CTI ablation. Results ICE-guidance demonstrated a statistically significant reduction in fluoroscopy time (72 [36; 170] s vs. 888 [578; 1184] s; p&amp;lt;0.01), total procedure time (70 [52; 90] min vs. 90 [60; 105] min; p&amp;lt;0.01), total ablation time (692 [435; 998] s vs. 920 [629; 1373] s; p&amp;lt;0.01), and the duration from the first to last ablation (20.5 [12; 37] min vs. 41.0 [26.8; 59.3] min; p&amp;lt;0.01). Both groups achieved a 100% acute success rate without major complications. The ICE-guided group exhibited a significantly superior long-term success rate (ICE-guided group: 95.74%, fluoroscopy-only group: 89.26%; p=0.048) compared to the fluoroscopy-only group at an average follow-up length of 34 months. Conclusion The utilization of ICE-guidance for CTI ablation significantly reduces fluoroscopy exposure, procedure time, and ablation time, ultimately contributing to enhanced long-term success rates when compared to the conventional fluoroscopy-only approach.

Impact of magnetic data collection prior to electroanatomic model creation on acute outcomes in de novo AF procedures

Abstract Background As ablation and electroanatomical mapping technology evolve, workflows change to maximize the impact on procedural efficacy, safety, and efficiency. In a magnetic-primary navigation mode, optimization of the magnetic-impedance field links (VoXels) must be considered to provide accurate environments for anatomic modeling, mapping, and lesion placement. To achieve this accuracy and optimize speed of data collection, many operators have adopted the strategy of collecting VoXels using an ablation catheter prior to introduction of a multipolar mapping catheter. However, the impact of this workflow on procedural metrics has not yet been quantified in a multicenter, international cohort. Objective Assess the impact of optimizing the magnetic navigation field using an ablation catheter prior to collecting left atrial (LA) data using a high-density diagnostic tool on acute outcomes in de novo atrial fibrillation (AF) ablation procedures. Methods Acute observational data from 199 de novo pulmonary vein isolation (PVI) cases was prospectively collected from 56 operators at 42 centers in Europe, the US, and Australia. Procedural metrics, modeling workflow, ablation technology used, and acute outcomes were collected. Results Of 199 de novo AF (62.3% PAF) ablation procedures, VoXels were collected with an ablation catheter prior to LA map collection with a multipolar catheter in 65/199 (32.7%) cases; the remainder collected with multipolar catheter first. An irrigated, contact force sensing RF ablation catheter was used in all procedures. Mean procedure duration was similar in procedures in which VoXels were collected prior to map collection (VC) compared to those that did not (nVC) (107.0±46.8 min and 115.4±59.2 min, respectively (p=0.28)). Mean fluoroscopy time was significantly reduced in VC cases compared to nVC cases (3.0±4.5 min and 5.3±5.6 min, respectively (p=0.002)). Total RF duration was significantly reduced in VC cases compared to nVC cases (904±444s and 1063±632s, respectively (p=0.04)). There was also a significant reduction in fluid delivered through the ablation catheter in VC cases, 369±159mL, compared to nVC cases, 520±243mL (p&amp;lt;0.001). Acute success rates were similar between groups: 98.5% for VC cases and 99.2% for nVC cases (p=0.64). Conclusion In this international cohort, cases where VoXels were collected prior to map and model collection had significantly reduced fluoroscopy times, RF durations, and fluid volumes delivered through the ablation catheter, potentially as a result of improved model quality. Despite the introduction of an additional step to the workflow, there was a trend toward shorter procedures when VoXels were collected prior to map and model collection, although it did not achieve statistical significance. Better quantification of the impact of this workflow on model quality, along with analysis of long-term patient outcomes, is warranted.Procedure Duration Comparison_VC vs. nVCFluoroscopy Comparison_VC vs. nVC

TIMES, ARE THEY A–CHANGING? IMPLANTATION AND FOLLOW–UP EXPERIENCE WITH LEADLESS PACEMAKERS (MICRA) AT PISA UNIVERSITY HOSPITAL

Abstract Background Leadless pacing represents a pivotal advancement in cardiac stimulation. Eliminating traditional pacing leads, leadless devices offer reduced complications, a bailout strategy for many previously challenging cases and streamlined procedures. Purpose This retrospective study aimed to compare, starting from December 1st 2023, newer implants (within the 3 years preceding Dec 1st 2023) and older implants (&amp;gt;3 years before) in a single–center experience with M–TPS (Micra Transcatheter Pacing System) in terms of safety and efficacy, at baseline and in a short–term follow–up (6 months). Methods A comprehensive analysis was conducted on 195 patients who underwent leadless pacemaker implantation at our Center, and that were followed–up for a minimum of 6 months. The cohort was stratified into two groups: recent (n=73) and less recent implants (n=122). Procedural variables, patient demographics, and clinical outcomes were documented. Post–implantation follow–up data include pacing threshold, fluoroscopy time, and other relevant variables. Results Comparison between the two groups revealed significant differences fluoroscopy time. Newer implants demonstrated a reduced fluoroscopy time [8 (IQR 5–12) vs 10 minutes (IQR 7–14)], suggesting potential advancements in technique. No significant differences were observed in other procedural or electrical parameters. Discussion: The comparison between older and newer leadless pacemaker implants reveals reassuring constancy in most parameters, suggesting the reliability of the M–TPS. The reduced fluoroscopy time aligns with the evolving proficiency of implanters and improved procedural efficiency. The dependable consistency observed across various parameters strengthens the confidence in the M–TPS, reinforcing its status as a reliable and effective solution for pacing. Conclusion The implantation and follow–up experience at our center elucidates very few differences between newer and older implants. This nuanced analysis contributes to the ongoing evolution of leadless pacemaker technology, which heralds a transformative era in cardiac care. With several years of implementation, accumulated follow–up data unveils valuable insights into its sustained effectiveness, guiding clinicians in optimizing patient outcomes and solidifying leadless pacing as a breakthrough in the realm of cardiac rhythm management.

Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study

BackgroundImplant choice for the fixation of femoral neck fracture is one of the most important management controversies. This study aims to evaluate and compare the short-term outcomes associated with the use of the Femoral Neck System (FNS), Multiple Cancellous Screws (MCS), and Dynamic Hip Screws (DHS) in treating femoral neck fractures in a young patient population.MethodsFrom June 2018 to June 2021, a total of 120 surgeries for a primary femoral neck fracture were retrospectively analyzed. This review encompassed demographic details of the patients and the mechanisms behind the injuries. Key surgical parameters such as operation duration, intraoperative blood loss, fluoroscopy duration, and hospital stay were meticulously documented. The employed surgical technique was described. All patients were followed up at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Avascular necrosis of the femoral head (AVN), nonunion, malreduction, implant failure or other complications were noted. The functional status at the last follow-up was assessed using the Harris functional scoring criteria.ResultsThere were 90 males and 30 females, with a mean age of 40.4 years. As to patient characteristics, there were no significant differences between the three groups. DHS group showed longer operation time(52.15 ± 4.80 min), more blood loss(59.05 ± 5.87 ml) and longer time of hospitalization(7.6 ± 0.90 d) than FNS group (39.65 ± 2.84 min, 45.33 ± 9.63 ml and 4.87 ± 0.48 d) and MCS group (39.45 ± 3.10 min, 48.15 ± 7.88 ml and 5.04 ± 0.49 d) (p < 0.05). In addition, the time of fluoroscopy in FNS group (15.45 ± 3.67) was less than that in MCS group (26.3 ± 4.76) and DHS group (27.1 ± 5.67) (p < 0.05). The cost of FNS group(44.51 ± 2.99 thousand RMB) was significantly higher than the MCS and DHS groups. The FNS, MCS and DHS groups showed a similar mean length of femoral neck shortening (LFNS) and Harris score. The FNS, MCS and DHS groups showed a similar mean rate of AVN and internal fixation failure.ConclusionsFollowing successful fracture reduction, FNS, MCS, and DHS are effective for in the young femoral neck fractures. No difference was found in complications between the three groups. However, the reduced fluoroscopy time associated with FNS contributes to shorter operation durations. The adoption of minimally invasive techniques correlates with decreased blood loss and shorter hospital stays. Nevertheless, these advantages may be offset by the potential economic burden they impose.

Comparison between a Novel Radiofrequency-Balloon and a Standard Cryo-Balloon in Pulmonary Vein Isolation: A Propensity-Score-Matched Analysis.

Background/Objectives: Single-shot devices are important tools for efficient pulmonary vein isolation (PVI) in atrial fibrillation (AF). In addition to the standard cryo-balloon (CB) catheter, a novel multi-electrode radiofrequency balloon-catheter (RFB, Heliostar, Biosense Webster, Irvine, CA, USA) with 3D-mapping-integration is available. Currently, there is no evidence allowing for a direct comparison between RFB-PVI and CB-PVI in a matched population. The study aimed to assess the procedural data, safety profiles, and outcomes of RFB-PVI versus CB-PVI. Methods: In this prospective registry study, symptomatic AF patients undergoing first-time PVI from January 2019 to April 2023, using RFB or CB, were included, with patients matched in a 1:2 ratio to reduce potential confounders. Results: The results from 171 consecutive RFB patients and 342 matched CB patients showed comparable recurrence-free survival after 12 months (81.3% RFB vs. 76.8% CB, p = 0.359). The RFB group had a longer procedure duration (88 vs. 73 min, p < 0.001) and longer fluoroscopy time (18.9 vs. 14.5 min, p < 0.001). Conclusions: In conclusion, the novel RFB system enables efficient and safe PVI, which is broadly comparable to the established CB system. However, the 3D-mapping integration in RFB did not reduce fluoroscopy time compared to CB.

Prospective evaluation of upper extremity access and total transfemoral approach during fenestrated and branched endovascular repair

ObjectiveTotal transfemoral (TF) access has been increasingly used during fenestrated-branched endovascular aortic repair (FB-EVAR). However, it is unclear whether the potential decrease in the risk of cerebrovascular events is offset by increased procedural difficulties and other complications. The aim of this study was to compare outcomes of FB-EVAR using a TF vs upper extremity (UE) approach for target artery incorporation. MethodsWe analyzed the clinical data of consecutive patients enrolled in a prospective, nonrandomized clinical trial in two centers to investigate the use of FB-EVAR for treatment of complex abdominal aortic aneurysms (CAAA) and thoracoabdominal aortic aneurysms (TAAA) between 2013 and 2022. Patients were classified into TF or UE access group with a subset analysis of patients treated using designs with directional branches. End points were technical success, procedural metrics, 30-day cerebrovascular events defined as stroke or transient ischemic attack, and any major adverse events (MAEs). ResultsThere were 541 patients (70% males; mean age, 74 ± 8 years) treated by FB-EVAR with 2107 renal-mesenteric TAs incorporated. TF was used in175 patients (32%) and UE in 366 patients (68%) including 146 (83%) TF and 314 (86%) UE access patients who had four or more TAs incorporated. The use of a TF approach increased from 8% between 2013 and 2017 to 31% between 2018 and 2020 and 96% between 2021 and 2022. Compared with UE access patients, TF access patients were more likely to have CAAAs (37% vs 24%; P = .002) as opposed to TAAAs. Technical success rate was 96% in both groups (P = .96). The use of the TF approach was associated with reduced fluoroscopy time and procedural time (each P < .05). The 30-day mortality rate was 0.6% for TF and 1.4% for UE (P = .67). There was no early cerebrovascular event in the TF group, but the incidence was 2.7% for UE patients (P = .035). The incidence of MAEs was also lower in the TF group (9% vs 18%; P = .006). Among 237 patients treated using devices with directional branches, there were no significant differences in outcomes except for a reduced procedural time for TF compared with UE access patients (P < .001). ConclusionsTF access was associated with a decreased incidence of early cerebrovascular events and MAEs compared with UE access for target artery incorporation. Procedural time was decreased in TF access patients irrespective of the type of stent graft design.

Comparison between conventional approach and three-dimensional mapping system in the catheter ablation of accessory pathway associated with coronary sinus diverticulum: A single-center experience.

Posteroseptal accessory pathways (APs) associated with coronary sinus (CS) diverticulum present a rare and challenge for ablation. This study aimed to compare the safety and efficacy of conventional approach and three-dimensional (3D) mapping system in the catheter ablation. This was a retrospective study of all patients (from January 2013 to July 2022) who underwent catheter ablation of posteroseptal AP associated with CS diverticula in our center. Patients who underwent catheter ablation using the traditional fluoroscopy method were included in the conventional method group (n = 13). Patients who underwent catheter ablation using the 3D mapping method were included in the 3D mapping group (n = 11). Clinical characteristics, ablation procedure, and outcomes were recorded and analyzed between the two groups. Out of 669 patients with posteroseptal APs, 24 of them (3.6%) were associated with CS diverticula. All patients in both groups successfully completed the electrophysiological study. In the conventional method group, two patients experienced complications (one patient with pericardial effusion and the other patient with femoral arterial hematoma), and two patients had recurrence. However, no patients suffered from complications or recurrence during follow-up. The procedure time and fluoroscopy time in the conventional method group were significantly longer than those in the 3D mapping method group. The utilization of 3D mapping led to reduced fluoroscopy time, shorter procedure duration, enhanced acute success rates, and decreased incidence of complications.

The effect of electro-anatomical mapping on the success rate and fluoroscopy time in supra-ventricular tachycardia ablation in children: single centre retrospective study.

To evaluate the effect of electro-anatomical mapping on success rate and fluoroscopy time in ablation of supraventricular tachycardia substrates in a large group of children. Patients referred from multiple centres in the Netherlands and who received a first ablation for supraventricular tachycardia substrates in the Leiden University Medical Center between 2014 and 2020 were included in this retrospective cohort study. They were divided in procedures in patients with fluoroscopy and procedures in patients using electro-anatomical mapping. Outcomes of ablation of 373 electro-anatomical substrates were analysed. Acute success rate in the fluoro-group (n = 170) was 95.9% compared to 94.5% in the electro-anatomical mapping group (n = 181) (p = 0.539); recurrence rate was 6.1% in the fluoro-group and 6.4% in the electro-anatomical mapping group (p = 0.911) after a 12-months follow-up. Redo-ablations were performed in 12 cases in the fluoro-group and 10 cases in the electro-anatomical mapping group, with a success rate of 83.3% versus 80.0%, resulting in an overall success rate of 95.9% in the fluoro-group and 92.8% in the electro-anatomical mapping group (p = 0.216) after 12 months. Fluoroscopy time and dose area product decreased significantly from 16.00 ± 17.75 minutes (median ± interquartile range) to 2.00 ± 3.00 minutes (p = 0.000) and 210.5 µGym2 ± 249.3 to 32.9 µGym2 ± 78.6 (p = 0.000), respectively. In the fluoro-group, four complications occurred (2.0%) and in the electro-anatomical mapping group no complications occurred. These results demonstrate that ablations of supraventricular tachycardia substrates in children remain a highly effective and safe treatment after the introduction of electro-anatomical mapping as a standard of care, while significantly reducing fluoroscopy time and dose area product.

High-density open window mapping vs conventional mapping in accessory pathways ablation

Abstract Background and purpose High density (HD) mapping is associated with a reduction in fluoroscopy time compared to conventional mapping in accessory pathway (AP) ablation. The Open Window (OW) technique (CARTO 3, Biosense Webster) is a new tool that automatically uses conventional electrophysiology criteria for AP location, as shorter local EGM AV interval (extended early meets late tool), earliest local activation time (LAT) and annotation at unipolar signal (wavefront annotation). However, no studies comparing its feasibility to conventional mapping have been conducted. Therefore, the aim of the present study was to assess the feasibility and the clinical implications of high-density OW mapping when compared to conventional HD mapping. Methods A prospective, unicentric cohort study was conducted that included consecutive patients which were referred to our institution for AP ablation with OW mapping technique and compared to a recent retrospective cohort of patients who underwent conventional HD mapping. Total fluoroscopy time, total mapping time and the rate of recurrence of the AP were compared between groups. A schematic step by step graphic of the workflow procedure is represented in figure 1. Results A total of 33 consecutive patients (32.28 ± 18 years, 58% males) were included in the OW group and compared with a cohort of 29 patients (29.6 ± 18 years, 52% males) who underwent conventional HD mapping. An example of Right Superior AP ablation is showed in figure 2. No differences in the location of the AP were observed (p=NS). OW mapping was associated to a lower mapping time (29.3 vs 37.8 min; p=0.04), lower fluoroscopy time (14.3 vs 21.3 min; p= 0.04) and lower radiofrequency time (p=0.007). After a median follow up of6 months, there were no differences in the rate of recurrence of the AP conduction between groups (p=NS). Conclusions In our experience, OW mapping was a feasible tool for AP location associated to a lower mapping time, lower radiofrequency time and lower X-ray exposure time with no differences in recurrence rate when compared to conventional HD mapping. However, more studies should be performed to corroborate these conclusions.Step by Step WorkflowRight Superior AP ablation

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.

Intracardiac Echocardiography Guidance Improves Procedural Outcomes in Patients Undergoing Cavotricuspidal Isthmus Ablation for Typical Atrial Flutter.

Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a method to reduce radiation exposure during CTI ablation. This study aims to comprehensively compare procedural parameters between ICE-guided CTI ablation and fluoroscopy-only procedures. A total of 370 consecutive patients were enrolled in our single-center retrospective study. In 151 patients, procedures were performed using fluoroscopy guidance only, while 219 patients underwent ICE-guided CTI ablation. ICE guidance significantly reduced fluoroscopy time (73 (36; 175) s vs. 900 (566; 1179) s; p < 0.001), fluoroscopy dose (2.45 (0.6; 5.1) mGy vs. 40.5 (25.7; 62.9) mGy; p < 0.001), and total procedure time (70 (52; 90) min vs. 87.5 (60; 102.5) min; p < 0.001). Total ablation time (657 (412; 981) s vs. 910 (616; 1367) s; p < 0.001) and the time from the first to last ablation (20 (11; 36) min vs. 40 (25; 55) min; p < 0.01) were also significantly shorter in the ICE-guided group. Acute success rate was 100% in both groups, and no major complications occurred in either group. ICE-guided CTI ablation in patients with AFL resulted in shorter procedure times, reduced fluoroscopy exposure, and decreased ablation times, compared to the standard fluoroscopy-only approach.

Effect of post-pyloric Dobhoff tube retention during gastrojejunostomy for reduction of fluoroscopic time and radiation dose.

The purpose of this study was to determine whether retention of a post-pyloric Dobhoff tube (DHT) in position to serve as a visual guide through the pylorus during gastrojejunostomy (GJ) tube placement results in a reduction in fluoroscopy time, procedure time, and estimated radiation dose. A retrospective study evaluated patients who underwent GJ tube placement or gastric to GJ conversion from January 1, 2017, to April 1, 2021. Demographic and procedural data were collected, and results were evaluated using descriptive statistics and hypothesis testing through an unpaired Student's t-test. Of the 71 GJ tube placements included for analysis, 12 patients underwent placement with a post-pyloric DHT in position, and 59 patients underwent placement without a post-pyloric DHT in position. The mean fluoroscopy time and estimated radiation dose were significantly reduced in patients who underwent GJ tube placement with a post-pyloric DHT in position compared with those without (7.08 min vs. 11.02 min, P = 0.004; 123.12 mGy vs. 255.19 mGy, P = 0.015, respectively). The mean total procedure time was also reduced in patients who underwent GJ tube placement with a post-pyloric DHT in position compared with those who had no post-pyloric DHT, but this finding lacked statistical significance (18.55 min vs. 23.15 min; P = 0.09). Post-pyloric DHT retention can be utilized during GJ tube placement to reduce radiation exposure to both the patient and interventionalist.

Right Heart Catheterization: An Antecubital Vein Approach to Reduce Fluoroscopy Time, Radiation Dose, and Guidewires Need.

Antecubital access for right heart catheterization (RHC) is a widespread technique, even though there is a need to clarify if there are differences and significant advantages compared to proximal vein access. To pursue this issue, we retrospectively identified patients who underwent RHC in our clinic over a 7 year period (between January 2015 and December 2022). We revised demographic, anthropometric, and procedural data, including the fluoroscopy time, the radiation exposure, and the use of guidewires. The presence of any complications was also assessed. In patients with antecubital access, the fluoroscopy time and the radiation exposure were lower compared to proximal vein access (6 vs. 3 min, mean difference of 2 min, CI 95% 1-4 min, p < 0.001 and 61 vs. 30 cGy/m2, mean difference 64 cGy/m2, CI 95% 50-77, p < 0.001). The number of patients requiring the use of at least one guidewire was lower in the group undergoing RHC through antecubital access compared to proximal vein access (55% vs. 43%, p = 0.01). The feasibility was optimal, as just 0.9% of procedures switched from antecubital to femoral access, with a negligible rate of complications. The choice of the antecubital site exhibits advantages, e.g., a shorter fluoroscopy time, a reduced radiation dose, and a lower average number of guidewires used compared to proximal vein access.

Utilization of 3D mapping systems in interventional electrophysiology and its impact on procedure time and fluoroscopy-Insights from the "Go for Zero Fluoroscopy" project.

The implementation of 3D mapping systems plays an important role in interventional electrophysiology (EP) in recent years. The aim of the present study was to evaluate use of 3D mapping systems regarding fluoroscopy and procedure duration. In the "Go for Zero Fluoroscopy" project 25 European centers provided data of consecutive EP procedures. Data on use of 3D mapping systems as well as utilization of contact force catheters and multipolar mapping catheters were associated with fluoroscopy time, dose area product (DAP), and procedure duration. A 3D mapping system was used in 966 (54%) cases. Use of 3D mapping for atrioventricular nodal reentry tachycardia (AVNRT) was associated with reduced fluoroscopy time (p<0.001), DAP (p=0.04) but increased procedure time (p=0.029). Moreover, fluoroscopy time (p<0.001) and DAP (p=0.005) were significantly lower in the 3D mapping group in ablation of typical atrial flutter. However, the procedure time (p<0.001) increased. Use of 3D mapping in the ablation of accessory pathway (AP) was associated with reduced fluoroscopy time (p<0.001) and DAP (p<0.001) with no significant increase in procedure time (p=0.066). In the case of atrial fibrillation, a 3D mapping system was used in 485 patients (75.8%). Additional use of a contact force catheter was associated with lower fluoroscopy time (p<0.001) and DAP (p<0.001). Use of a multipolar mapping catheter was associated with lower fluoroscopy time (p=0.002). The implementation of 3D mapping systems in the ablation of ventricular tachycardias resulted in a significant increase in the procedure time (p=0.001) without significant differences regarding the DAP (p=0.773) and fluoroscopy time (p=0.249). Use of 3D mapping systems in ablation of supraventricular tachycardias is associated with lower radiation exposure. Nevertheless, the procedure time often increases, except in the case of ablation for AP. Use of contact force catheters and multipolar mapping catheters is associated with yet lower radiation exposure values. Prospective randomized studies are needed to further elucidate potential benefit of these technological tools.

Transjugular intrahepatic portosystemic shunt creation (TIPS) in the angio-CT—a hybrid intervention with image fusion

ObjectiveFor transjugular intrahepatic portosystemic shunt (TIPS) creation, ultrasound guidance for portal vein puncture is strongly recommended. However, outside regular hours of service, a skilled sonographer might be lacking. Hybrid intervention suites combine CT imaging with conventional angiography allowing to project 3D information into the conventional 2D imaging and further CT-fluoroscopic puncture of the portal vein. The purpose of this study was to assess whether TIPS using angio-CT facilitates the procedure for a single interventional radiologist.MethodsAll TIPS procedures from 2021 and 2022 which took place outside regular working hours were included (n = 20). Ten TIPS procedures were performed with just fluoroscopy guidance and ten procedures using angio-CT. For the angio-CT TIPS, a contrast-enhanced CT was performed on the angiography table. From the CT, a 3D volume was created using virtual rendering technique (VRT). The VRT was blended with the conventional angiography image onto the live monitor and used as guidance for the TIPS needle. Fluoroscopy time, area dose product, and interventional time were assessed.ResultsHybrid intervention with angio-CT did lead to a significantly shorter fluoroscopy time and interventional time (p = 0.034 for both). Mean radiation exposure was significantly reduced, too (p = 0.04). Furthermore, the mortality rate was lower in patients who underwent the hybrid TIPS (0% vs 33%).ConclusionTIPS procedure in angio-CT performed by only one interventional radiologist is quicker and reduces radiation exposure for the interventionalist compared to mere fluoroscopy guidance. The results further indicate increased safety using angio-CT.Clinical relevance statementThis study aimed to evaluate the feasibility of using angio-CT in TIPS procedures during non-standard working hours. Results indicated that the use of angio-CT significantly reduced fluoroscopy time, interventional time, and radiation exposure, while also leading to improved patient outcomes.Key Points• Image guiding such as ultrasound is recommended for transjugular intrahepatic portosystemic shunt creation but might be not available for emergency cases outside of regular working hours.• Transjugular intrahepatic portosystemic shunt creation using an angio-CT with image fusion is feasible for only one physician under emergency settings and results in lower radiation exposure and faster procedures.• Transjugular intrahepatic portosystemic shunt creation using an angio-CT with image fusion seems to be safer than using mere fluoroscopy guidance.