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Sommer P, Sciacca V, Anselmino M, Tilz R, Bourier F, Lehrmann H, Bulava A. Practical guidance to reduce radiation exposure in electrophysiology applying ultra low-dose protocols: a European Heart Rhythm Association review. Europace 2023; 25:euad191. [PMID: 37410906 PMCID: PMC10365833 DOI: 10.1093/europace/euad191] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Interventional electrophysiology offers a great variety of treatment options to patients suffering from symptomatic cardiac arrhythmia. Catheter ablation of supraventricular and ventricular tachycardia has globally evolved a cornerstone in modern arrhythmia management. Complex interventional electrophysiological procedures engaging multiple ablation tools have been developed over the past decades. Fluoroscopy enabled interventional electrophysiologist throughout the years to gain profound knowledge on intracardiac anatomy and catheter movement inside the cardiac cavities and hence develop specific ablation approaches. However, the application of X-ray technologies imposes serious health risks to patients and operators. To reduce the use of fluoroscopy during interventional electrophysiological procedures to the possibly lowest degree and to establish an optimal protection of patients and operators in cases of fluoroscopy is the main goal of modern radiation management. The present manuscript gives an overview of possible strategies of fluoroscopy reduction and specific radiation protection strategies.
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Affiliation(s)
- Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, ‘Citta della Salute e della Scienza di Torino’ Hospital, University of Turin, Torino, Italy
| | - Roland Tilz
- University Heart Center Lübeck, Department of Rhythmology, University Hospital Schleswig-Holstein, Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University, Munich, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology (Campus Bad Krozingen), University Hospital Freiburg, Bad Krozingen, Germany
| | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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Miyazaki Y, Yamagata K, Wakamiya A, Shimamoto K, Ueda N, Nakajima K, Kamakura T, Wada M, Ishibashi K, Inoue Y, Miyamoto K, Nagase S, Aiba T, Kusano K. Adding interactive face-to-face lectures to passive lectures effectively reduces radiation exposure during atrial fibrillation ablation. J Cardiol 2023; 81:464-468. [PMID: 36822546 DOI: 10.1016/j.jjcc.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Radiation exposure remains a major concern for electrophysiologists and patients. This study aimed to investigate the effect of altering awareness of radiation exposure during atrial fibrillation ablation using interactive face-to-face (FTF) lectures compared to passive lectures. METHODS Patients who underwent their first catheter ablation with radiofrequency energy for atrial fibrillation between January 2014 and December 2020 were included in this study. All operators attended an e-learning lecture on radiation exposure before catheter ablation. The addition of FTF lectures to this lecture was introduced in 2018. The effect on radiation exposure was compared between the pre-FTF and FTF periods by comparing fluoroscopy time and radiation dose. RESULTS A total of 896 patients [mean age, 66 ± 11 years; 603 men (67 %)] were included in this study. For pre-FTF (n = 345), only pulmonary vein isolation (PVI) was performed in 112 patients and PVI with additional ablation in 233 patients. For FTF lectures (n = 551), PVI-only was performed in 302 patients and PVI with additional ablation in 249 patients. Fluoroscopy time, cumulative air kerma, and cumulative air kerma per time significantly reduced after FTF introduction in both PVI-only group [pre-FTF and FTF; 37 ± 15 min and 16 ± 10 min (p < 0.0001), 477 ± 582 mGy and 108 ± 156 mGy (p < 0.0001), 11 ± 12 mGy/min, and 5 ± 6 mGy/min (p < 0.0001), respectively] and PVI with additional ablation group [pre-FTF and FTF; 48 ± 17 min and 15 ± 13 min (p < 0.0001), 613 ± 483 mGy and 68 ± 96 mGy (p < 0.0001), 12 ± 10 mGy/min, and 4 ± 4 mGy/min (p < 0.0001), respectively]. There were no significant differences in intraoperative complications between the two periods. CONCLUSIONS FTF lectures can reduce radiation exposure.
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Affiliation(s)
- Yuichiro Miyazaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Akinori Wakamiya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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4
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Lurie A, Amit G, Divakaramenon S, Acosta JG, Healey JS, Wong JA. Outcomes and Safety of Fluoroless Catheter Ablation for Atrial Fibrillation. CJC Open 2020; 3:303-310. [PMID: 33778447 PMCID: PMC7984996 DOI: 10.1016/j.cjco.2020.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Intracardiac echocardiography and 3D mapping systems allow catheter ablation for atrial fibrillation (AF) to be conducted without fluoroscopy; however, the safety and effectiveness of fluoroless AF ablation are not well defined. Methods We examined consecutive radiofrequency AF catheter ablations at a large academic teaching hospital from November 2017 to July 2019. Outcomes for fluoroscopy-guided (N = 176) and fluoroless (N = 147) ablations were compared. Cases were designated as fluoroless at the outset of the procedure. Results Mean age was 59.5 ± 10 years, 66.9% were male, 71.8% had paroxysmal AF, and the mean CHA2DS2-VASc score was 1.7 ± 1.4. There were no differences in patient baseline characteristics. In the fluoroless group, minimal fluoroscopy was used in 17 patients (median, 3 seconds; interquartile range, 1.2-4.8). Mean procedure time, fluoroscopy time, and radiation dose (± standard deviation) were greater in the fluoroscopy group compared with the fluoroless group (194 ± 56 vs 176 ± 46 minutes, P = 0.0021; 10.7 ± 6.6 vs 0.008 ± 0.03 minutes, P < 0.0001; 2759.2 ± 1911 vs 5.4 ± 24 μGy m2, P < 0.0001). In multivariable linear regression models, fluoroless AF ablation was independently associated with reduced procedure times (ß = −16.5 minutes, P = 0.01). Acute procedural success (95.5% vs 98.6%, P = 0.1), complication rates (4.5% vs 2.0%, P = 0.24), and 1-year AF recurrence rates (28.7% vs 27.1%, log-rank P = 0.69) were similar between fluoroscopy and fluoroless groups. Excluding the 17 patients receiving fluoroscopy in the fluoroless group did not impact our results (P = 0.013). After exclusion of redo cases, fluoroless AF ablation was no longer associated with reduced procedure times (ß = −11.4 minutes, P = 0.106). Conclusions Fluoroless radiofrequency AF ablation had similar effectiveness and safety compared with conventional fluoroscopy-guided AF ablation.
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Affiliation(s)
- Antony Lurie
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Guy Amit
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Syamkumar Divakaramenon
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - J Gabriel Acosta
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jorge A Wong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
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Desai M, Kahaly O, Aslam A, Saifa-Bonsu J, Usmani M, Okabe T, Afzal MR, Houmsse M. Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review. Expert Rev Med Devices 2020; 17:1183-1192. [PMID: 32885677 DOI: 10.1080/17434440.2020.1819789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiac electrophysiology (EP) procedures are frequently performed in patients with cardiac arrhythmias, chronic heart failure, and sudden cardiac death. Most EP procedures involve fluoroscopy, which results in radiation exposure to physicians, patients, and EP lab staff. Accumulated radiation exposure is a known health detriment to patients and physicians. AREA COVERED This review will summarize radiation exposure, dose metrics, complications of radiation exposure, factors affecting radiation exposure, minimizing radiation exposure, zero or near-zero fluoroscopy strategies, and up-to-date research in the area of reducing radiation exposure and best practices. EXPERT COMMENTARY Comprehensive strategies should be implemented in EP laboratories to minimize radiation exposure with standard fluoroscopy. There are routine techniques that can mitigate significant amounts of radiation exposure using standard equipment within the EP lab. The operators need to emphasize that EP practices routinely incorporate non-ionizing radiation sources for cardiac imaging (e.g. magnetic resonance imaging, advanced electroanatomical mapping systems, intracardiac ultrasonography) in addition to other novel technologies to mitigate radiation exposure to patients and physicians.
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Affiliation(s)
| | - Omar Kahaly
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Adil Aslam
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Jonnie Saifa-Bonsu
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Maham Usmani
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Wexner Medical Center at the Ohio State University Medical Center , Columbus, OH, USA
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7
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Romero J, Patel K, Briceno D, Alviz I, Tarantino N, Della Rocca DG, Natale V, Zhang XD, Di Biase L. Fluoroless Atrial Fibrillation Catheter Ablation: Technique and Clinical Outcomes. Card Electrophysiol Clin 2020; 12:233-245. [PMID: 32451107 DOI: 10.1016/j.ccep.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fluoroscopy continues to be considered an indispensable part of atrial fibrillation (AF) ablation worldwide. Deleterious effects of radiation exposure to patients, physicians, and catheter laboratory personnel are gaining increased consideration. Safety and efficacy of a fluoroless approach for AF ablation is comparable with outcomes achieved with fluoroscopy use. This article focuses on AF ablation with zero fluoroscopy use as well as current evidence on efficacy and safety of this technique. In contrast, minimal fluoroscopy is an alternative. Relying on intracardiac echocardiography for transseptal access and electroanatomic mapping for catheter manipulation can help implement this approach on a wider scale.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Kavisha Patel
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - David Briceno
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Nicola Tarantino
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | | | - Veronica Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Xiao-Dong Zhang
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
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8
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Haines DE. A paradigm shift to address occupational health risks in the EP laboratory. Heart Rhythm 2020; 17:681-682. [DOI: 10.1016/j.hrthm.2019.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
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9
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Ueda A, Soejima K, Miwa Y, Takeuchi S, Nagaoka M, Momose Y, Matsushita N, Hoshida K, Miyakoshi M, Togashi I, Maeda A, Hagiwara Y, Sato T, Yoshino H. Idiopathic Ventricular Arrhythmia Ablation Using Non-Fluoroscopic Catheter Visualization System. Int Heart J 2019; 60:78-85. [DOI: 10.1536/ihj.18-122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University Hospital
| | | | - Mika Nagaoka
- Department of Cardiology, Kyorin University Hospital
| | - Yuichi Momose
- Department of Cardiology, Kyorin University Hospital
| | | | - Kyoko Hoshida
- Department of Cardiology, Kyorin University Hospital
| | | | - Ikuko Togashi
- Department of Cardiology, Kyorin University Hospital
| | - Akiko Maeda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | - Yo Hagiwara
- Division of Engineering, Kyorin University Hospital
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
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10
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Zei PC, Hunter TD, Gache LM, O'Riordan G, Baykaner T, Brodt CR. Low-fluoroscopy atrial fibrillation ablation with contact force and ultrasound technologies: a learning curve. Pragmat Obs Res 2019; 10:1-7. [PMID: 30666175 PMCID: PMC6330962 DOI: 10.2147/por.s181220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Fluoroscopy exposure during catheter ablation is a health hazard to patients and operators. This study presents the results of implementing a low-fluoroscopy workflow using modern contact force (CF) technologies in paroxysmal atrial fibrillation (PAF) ablation. Methods A fluoroscopy reduction workflow was implemented and subsequent catheter ablations for PAF were evaluated. After vascular access with ultrasound guidance, a THERMOCOOL SMARTTOUCH® Catheter (ST) was advanced into the right atrium. The decapolar catheter was placed without fluoroscopy. A double-transseptal puncture was performed under intracardiac echocardiography guidance. ST and mapping catheters were advanced into the left atrium. A left atrial map was created, and pulmonary vein (PV) isolation was confirmed via entrance and exit block before and after the administration of isoproterenol or adenosine. Results Forty-three patients underwent PAF ablation with fluoroscopy reduction workflow (mean age: 66±9 years; 70% male), performed by five operators. Acute success rate (PV isolation) was 96.5% of PVs. One case of pericardial effusion, not requiring intervention, was the only acute complication. Mean procedure time was 217±42 minutes. Mean fluoroscopy time was 2.3±3.0 minutes, with 97.7% of patients having < 10 minutes and 86.0% having < 5 minutes. A significant downward trend over time was observed, suggesting a rapid learning curve for fluoroscopy reduction. Freedom from any atrial arrhythmias without reablation was 80.0% after a mean follow-up of 12±3 months. Conclusion Low fluoroscopy time is achievable with CF technologies after a short learning curve, without compromising patient safety or effectiveness.
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Affiliation(s)
- Paul C Zei
- Cardiac Electrophysiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tina D Hunter
- Real World Evidence, CTI Clinical Trial and Consulting Services, Covington, KY, USA,
| | - Larry M Gache
- Real World Evidence, CTI Clinical Trial and Consulting Services, Covington, KY, USA,
| | - Gerri O'Riordan
- Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Tina Baykaner
- Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Chad R Brodt
- Cardiovascular Medicine, Stanford University, Stanford, CA, USA
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11
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Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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12
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Kim J. Non-fluoroscopic Catheter Tracking System for Atrial Fibrillation Ablation. Korean Circ J 2018; 49:97-98. [PMID: 30468033 PMCID: PMC6331327 DOI: 10.4070/kcj.2018.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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13
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Rate of acquired pulmonary vein stenosis after ablation of atrial fibrillation referred to electroanatomical mapping systems: Does it matter? Cardiol J 2018; 26:451-458. [PMID: 30246235 DOI: 10.5603/cj.a2018.0114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). It is currently unclear if routine screening for PVS by imaging (echocardiography, computed tomography) is clinically meaningful and if there is a correlation between PVS and the electroanatomical mapping system (EAMS) used for the ablation procedure. It was therefore investigated in the current single center experience. METHODS All patients from January 2004 to December 2016 with the diagnosis of PVS after interventional ablation of AF by radiofrequency were retrospectively analyzed. From 2004 to 2007, transesophageal echocardiography was routinely performed as screening for RFA-acquired PVS (group A). Since 2008, diagnostics were only initiated in cases of clinical symptoms suggestive for PVS (group B). RESULTS The overall PVS rate after interventional RFA for AF of the documented institution is 0.72% (70/9754). The incidence was not influenced by screening: group A had a 0.74% PVS rate and group B a 0.72% rate (NS). Referred to as the EAMS, there were significant differences: 20/4229 (0.5%) using CARTO®, 48/4510 (1.1%) using EnSite®, 1/853 (0.1%) using MediGuide®, and 1/162 (0.6%) using Rhythmia®. Since 2009, no significant difference between technologies was found. CONCLUSIONS The present analysis of 9754 procedures revealed 70 cases of PVS. The incidence of PVS is not related to screening but to the application of different EAMS. Possible explanations are technological backgrounds (magnetic vs. electrical), learning curves, operator experience, and work-flow differences. Furthermore, incorporation of new technologies seems to be associated with higher incidences of PVS before workflows are optimized.
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14
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Yamada S, Lo LW, Lin YJ, Chang SL, Chung FP, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chen SA. The Accuracy and Clinical Applicability of a Sensor Based Electromagnetic Non-fluoroscopic Catheter Tracking System. Korean Circ J 2018; 49:84-96. [PMID: 30468028 PMCID: PMC6331321 DOI: 10.4070/kcj.2018.0195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives The differences between electromagnetic-based mapping (EM) and impedance-based mapping (IM) in 3D anatomical reconstruction have not been fully clarified. We aimed to investigate the anatomical accuracy between EM (MediGuide™) and IM (EnSite Velocity™) systems. Methods We investigated 15 consecutive patients (10 males, mean age 58±9 years) who underwent pulmonary veins (PVs) isolation for paroxysmal atrial fibrillation (PAF). Contrast-enhanced computed tomography (CT) image of the left atrium (LA) was acquired before ablation and the 3D geometry of the LA was constructed using EM during ablation procedure. We measured the 4 PV angles between the main trunk of each PV and the posterior LA after field scaling. Additionally, the posterior LA surface area was measured. The variables were compared to those of CT-based geometry. A control group of 40 patients who underwent conventional PVs isolation using IM were also evaluated. Results The actual and relative changes of EM and CT-based geometry in all PV angles and posterior LA were significantly smaller compared to those of IM and CT-based geometry. Intraclass correlation coefficient (ICC) between EM and CT-based geometry were 0.871 (right superior pulmonary vein [RSPV]), 0.887 (right inferior pulmonary vein [RIPV]), 0.853 (left superior pulmonary vein [LSPV]), 0.911 (left inferior pulmonary vein [LIPV]), and 0.833 (posterior LA). On the other hand, ICC between IM and CT-based geometry were 0.548 (RSPV), 0.639 (RIPV), 0.691 (LSPV), 0.706 (LIPV), and 0.568 (posterior LA). Conclusions Image integration with EM enables high accurate visualization of cardiac anatomy compared to IM in PAF ablation.
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Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Li Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fa Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chin Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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15
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Schnur M, Wannagat S, Loehr L, Lask S, Mügge A, Wutzler A. [Radiation reduction in interventional electrophysiology : Results from operators with different levels of experience]. Herzschrittmacherther Elektrophysiol 2018; 29:406-410. [PMID: 30155562 DOI: 10.1007/s00399-018-0589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radiation exposure in the catherization laboratory is associated with significant health risks. It is unclear whether a reduction of radiation exposure with the use of "near-zero fluoroscopy" protocols is possible when applied by less experienced operators. METHODS Consecutive ablation procedures with the use of a 3D mapping system were analyzed. Three time periods were analyzed. During the first period (standard), no specific radiation-reduction protocol was used. During the second period (initial phase of radiation reduction) a near "near-zero fluoroscopy" protocol was implemented; however, the majority of procedures were performed by an expert. During the third period (routine use of radiation reduction), less experienced operators (fellow and beginner) performed a growing number of procedures with the "near-zero fluoroscopy" protocol. RESULTS In all, 290 procedures were analyzed. After implementation of a radiation-reduced protocol, a significant reduction of radiation exposure was observed (standard 850 ± 831.7 vs. initial phase 197.2 ± 481.8 μGy/m2, p < 0.001, and vs. routine use 283 ± 493.8 μGy/m2, p < 0.001). No significant difference was observed between the initial phase and routine phase (p = 1). Over the three periods, the proportion of procedures performed by less experienced operators grew significantly for complex (fellow: 0% vs. 10% vs. 30%; p < 0.001) and noncomplex procedures (fellow: 30% vs. 39% vs. 49%; beginner: 15% vs. 38% vs. 34%; p = 0.002). Complication rates were not significantly different. CONCLUSIONS Implementation of a radiation-reduced protocol leads to a significant reduction of radiation exposure even in less experienced operators during training.
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Affiliation(s)
- Miriam Schnur
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Severin Wannagat
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Lena Loehr
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Sebastian Lask
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Andreas Mügge
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Alexander Wutzler
- Kardiovaskuläres Zentrum, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
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16
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Rogers AJ, Brodt CR. Minimizing Radiation in the Modern Electrophysiology Laboratory. J Innov Card Rhythm Manag 2018; 9:3265-3270. [PMID: 32494501 PMCID: PMC7252826 DOI: 10.19102/icrm.2018.090805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
Historically, the electrophysiology laboratory has relied heavily on the use of ionizing radiation in the form of fluoroscopy for a broad range of interventions and diagnostics. As the harmful effects of radiation have become increasingly recognized and procedural technologies have advanced, electrophysiologists have adopted new workflows. The purpose of this article is to review the available literature and experience in minimizing radiation in the modern electrophysiology laboratory. This review first covers general approaches to reducing fluoroscopy radiation in the electrophysiology suite, with concepts that apply across all procedure types. These include the reduction of infrared emission through fastidious fluoroscopy settings, new and proven solutions for radiation shielding, and methods of creating distance between the radiation source and the operator to reduce exposure. Following this discussion, we review specific task-based techniques for reducing radiation during special electrophysiologic procedures and workflows such as vascular access, coronary sinus lead placement, catheter manipulation, and periprocedural planning studies.
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Affiliation(s)
- Albert J Rogers
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Chad R Brodt
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
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17
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Huang X, Chen Y, Huang Z, He L, Liu S, Deng X, Wang Y, Li R, Xu D, Peng J. Catheter radiofrequency ablation for arrhythmias under the guidance of the Carto 3 three-dimensional mapping system in an operating room without digital subtraction angiography. Medicine (Baltimore) 2018; 97:e11044. [PMID: 29923993 PMCID: PMC6023703 DOI: 10.1097/md.0000000000011044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Several studies have reported the efficacy of a zero-fluoroscopy approach for catheter radiofrequency ablation of arrhythmias in a digital subtraction angiography (DSA) room. However, no reports are available on the ablation of arrhythmias in the absence of DSA in the operating room. To investigate the efficacy and safety of catheter radiofrequency ablation for arrhythmias under the guidance of a Carto 3 three-dimensional (3D) mapping system in an operating room without DSA. Patients were enrolled according to the type of arrhythmia. The Carto 3 mapping system was used to reconstruct heart models and guide the electrophysiologic examination, mapping, and ablation. The total procedure, reconstruction, electrophysiologic examination, and mapping times were recorded. Furthermore, immediate success rates and complications were also recorded. A total of 20 patients were enrolled, including 12 males. The average age was 51.3 ± 17.2 (19-76) years. Nine cases of atrioventricular nodal re-entrant tachycardia, 7 cases of frequent ventricular premature contractions, 3 cases of Wolff-Parkinson-White syndrome, and 1 case of typical atrial flutter were included. All arrhythmias were successfully ablated. The procedure time was 127.0 ± 21.0 (99-177) minutes, the reconstruction time was 6.5 ± 2.9 (3-14) minutes, the electrophysiologic study time was 10.4 ± 3.4 (6-20) minutes, and the mapping time was 11.7 ± 8.3 (3-36) minutes. No complications occurred. Radiofrequency ablation of arrhythmias without DSA is effective and feasible under the guidance of the Carto 3 mapping system. However, the electrophysiology physician must have sufficient experience, and related emergency measures must be present to ensure safety.
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Affiliation(s)
| | - Yanjia Chen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou
| | | | | | | | | | - Yongsheng Wang
- The Second People's Hospital of Jiedong District, Jieyang
| | - Rucheng Li
- Guangning County People's Hospital, Zhaoqing, Guangdong Province, China
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18
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Borlich M, Iden L, Kuhnhardt K, Paetsch I, Hindricks G, Sommer P. 3D Mapping for PVI- Geometry, Image Integration and Incorporation of Contact Force Into Work Flow. J Atr Fibrillation 2018; 10:1795. [PMID: 29988269 DOI: 10.4022/jafib.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/19/2018] [Accepted: 02/18/2018] [Indexed: 12/16/2022]
Abstract
Catheter ablation of atrial fibrillation has evolved enormously thanks to rapid improvement of modern mapping technologies, progress in catheter development and current possibilities for reduction of radiation exposure. Pulmonary vein isolation is thereby the cornerstone in this interventional treatment. Increased precision of catheter localization by modern three-dimensional mapping systems, faster and better processing of local electrograms and their immediate color-based visualization make it possible to treat even challenging arrhythmias very effectively. The commonly used three-dimensional mapping systems CARTO 3 (Biosense Webster, Irvine, Ca.) and Ensite Precision (St. Jude Medical, St. Paul, Min) differ in construction and principles of the underlying mapping technology. In this review article, we aim to emphasize the most important aspects of possibilities that make both systems so valuable for interventional treatment of atrial fibrillation. We present a modern workflow, that unites three-dimensional LA mapping with collecting relevant local information, image integration for refining the map and beneficial use of contact force based ablation approach.
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Affiliation(s)
- Martin Borlich
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Leon Iden
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Ingo Paetsch
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Philipp Sommer
- Department of Electrophysiology, Heart Center, Leipzig, Germany
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19
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Lehrmann H, Jadidi AS, Minners J, Keyl C, Hochholzer W, Carrapatoso F, Trenk D, Weber R, Arentz T. Important reduction of the radiation dose for pulmonary vein isolation using a multimodal approach. Europace 2018; 20:279-287. [PMID: 28011800 DOI: 10.1093/europace/euw334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/29/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The number of pulmonary vein isolation (PVI) ablation procedures is steadily increasing worldwide resulting in a substantial radiation exposure to patients and operators. The aim of our study was to reduce radiation exposure during these procedures to a critical amount without compromising patient safety. Methods and results First, we assessed radiation exposure for primary PVI procedures over time (2005-2015) at the University Heart Center Freiburg-Bad Krozingen. Second, we prospectively evaluated in 52 patients, the efficacy and safety of a novel radiation reduction program (particularly applying an enhanced fluoroscopy pulse dose-reduction and optimized 3D-mapping system use). In 2035 primary PVI procedures, radiation exposure, assessed as estimated effective dose (eED in mSv, dose area product * 0.002 * conversion factor for females), fluoroscopy-time, and procedure-time decreased significantly from 2005 to 2015 (e.g. eED decreased from 9.3 (interquartile range (IQR) 6.4-13.4) mSv to 0.9 (IQR 0.5-1.6) mSv, p for trend <0.001). Importantly, application of the enhanced radiation reduction program further reduced eED to 0.4 mSv (IQR 0.3-0.6, P < 0.001 vs. control), a value not significantly different from slow-pathway ablation procedures (P = 0.41). Multiple linear regression analysis identified the radiation reduction program as the only independent variable associated with a decrease in radiation exposure. Conclusion Radiation exposure during PVI decreased over the last decade and can further be reduced significantly by the implementation of an enhanced radiation reduction program.
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Affiliation(s)
- Heiko Lehrmann
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Amir S Jadidi
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Cornelius Keyl
- Department of Anesthesiology, University Heart Center Freiburg/Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Filipe Carrapatoso
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Reinhold Weber
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
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20
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Sommer P, Bertagnolli L, Kircher S, Arya A, Bollmann A, Richter S, Rolf S, Hindricks G. Safety profile of near-zero fluoroscopy atrial fibrillation ablation with non-fluoroscopic catheter visualization: experience from 1000 consecutive procedures. Europace 2018; 20:1952-1958. [DOI: 10.1093/europace/eux378] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/16/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
- Leipzig Heart Institute (LHI), Trendelenburgstr. 16, Leipzig, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Simon Kircher
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Sascha Rolf
- Department of Cardiology, DRK Kliniken Berlin Westend, Spandauer Damm 130, Berlin, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
- Leipzig Heart Institute (LHI), Trendelenburgstr. 16, Leipzig, Germany
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21
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Thibault B, Macle L, Mondésert B, Dubuc M, Shohoudi A, Dyrda K, Guerra PG, Rivard L, Roy D, Talajic M, Khairy P. Reducing radiation exposure during procedures performed in the electrophysiology laboratory. J Cardiovasc Electrophysiol 2017; 29:308-315. [PMID: 29064134 DOI: 10.1111/jce.13373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Expert societies recently published strong recommendations to reduce the exposure of patients and staff to ionizing radiation (IR) during interventional and electrophysiology (EP) procedures. However, adherence to these guidelines remains difficult and the impact of implementing such recommendations is poorly characterized. METHODS AND RESULTS We conducted a single-center cohort study to quantify radiation exposure over time in three EP laboratories at the Montreal Heart Institute during 5,546 consecutive procedures from 2012 to 2015 by 11 primary operators. Overall, 2,618 (47.2%) procedures were catheter-based and 2,928 (52.8%) were device interventions. Interventions to reduce radiation exposure included educational initiatives to raise awareness (i.e., limiting cine acquisition, patient position, table height), slower frame rate, lower radiation dose per pulse, collimation, and integration with 3-D mapping systems and/or MediGuide technology. An 85% reduction in IR exposure was observed from 2012 to 2015, with the mean dose-area-product (DAP) decreasing from 7.65 ± 0.05 Gy·cm2 to 1.15 ± 0.04 Gy·cm2 (P < 0.001). This was true for catheter-based procedures (mean DAP 16.99 ± 0.08 to 2.00 ± 0.06 Gy·cm2 , P < 0.001) and device interventions (mean DAP 4.18 ± 0.06 to 0.64 ± 0.05 Gy·cm2 , P < 0.001). The median effective dose of IR recorded per quarter by 282 cervical dosimeters on EP staff decreased from 0.57 (IQR 0.18, 1.03) mSv in 2012 to 0.00 (IQR 0.00, 0.19) mSv in 2015, P < 0.001. CONCLUSION Enforcing good clinical practices with simple measures and low-dose fluoroscopy settings are highly effective in reducing IR exposure in the EP lab. These promising results should encourage other EP labs to adopt similar protective measures.
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Affiliation(s)
- Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Blandine Mondésert
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Azadeh Shohoudi
- Montreal Health Innovations Coordinating Center, Montreal Heart Innovations Coordinating Center, Montrel Heart Institute, Université de Montréal, Montréal, Canada
| | - Katia Dyrda
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Peter G Guerra
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Léna Rivard
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute and the Department of Medicine, Université de Montréal, Montréal, Canada
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22
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Piorkowski C, Breithardt OA, Razavi H, Nabutovsky Y, Rosenberg SP, Markovitz CD, Arya A, Rolf S, John S, Kosiuk J, Olson E, Eitel C, Huo Y, Döring M, Richter S, Ryu K, Gaspar T, Prinzen FW, Hindricks G, Sommer P. Mapping-guided characterization of mechanical and electrical activation patterns in patients with normal systolic function using a sensor-based tracking technology. Europace 2017; 19:1700-1709. [PMID: 27738070 DOI: 10.1093/europace/euw261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/29/2016] [Indexed: 11/14/2022] Open
Abstract
Aims In times of evolving cardiac resynchronization therapy, intra-procedural characterization of left ventricular (LV) mechanical activation patterns is desired but technically challenging with currently available technologies. In patients with normal systolic function, we evaluated the feasibility of characterizing LV wall motion using a novel sensor-based, real-time tracking technology. Methods and results Ten patients underwent simultaneous motion and electrical mapping of the LV endocardium during sinus rhythm using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, SJM). Epicardial motion data were also collected simultaneously at corresponding locations from accessible coronary sinus branches. Displacements at each mapping point and times of electrical and mechanical activation were combined over each of the six standard LV wall segments. Mechanical activation timing was compared with that from electrical activation and preoperative 2D speckle tracking echocardiography (echo). MediGuide-based displacement data were further analysed to estimate LV chamber volumes that were compared with echo and magnetic resonance imaging (MRI). The lateral and septal walls exhibited the largest (12.5 [11.6-15.0] mm) and smallest (10.2 [9.0-11.3] mm) displacement, respectively. Radial displacement was significantly larger endocardially than epicardially (endo: 6.7 [5.0-9.1] mm; epi: 3.8 [2.4-5.6] mm), while longitudinal displacement was significantly larger epicardially (endo: 8.0 [5.0-10.6] mm; epi: 10.3 [7.4-13.8] mm). Most often, the anteroseptal/anterior and lateral walls showed the earliest and latest mechanical activations, respectively. 9/10 patients had concordant or adjacent wall segments of latest mechanical and electrical activation, and 6/10 patients had concordant or adjacent wall segments of latest mechanical activation as measured by MediGuide and echo. MediGuide's LV chamber volumes were significantly correlated with MRI (R2= 0.73, P < 0.01) and echo (R2= 0.75, P < 0.001). Conclusion The feasibility of mapping-guided intra-procedural characterization of LV wall motion was established. Clinical trial registration http://www.clinicaltrials.gov; Unique identifier: CT01629160.
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Affiliation(s)
- Christopher Piorkowski
- Department of Invasive Electrophysiology, University of Dresden-Heart Center, Dresden, Germany
| | - Ole-A Breithardt
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | | | | | | | | | - Arash Arya
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Silke John
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | | | - Charlotte Eitel
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Yan Huo
- Department of Invasive Electrophysiology, University of Dresden-Heart Center, Dresden, Germany
| | - Michael Döring
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | | | - Thomas Gaspar
- Department of Invasive Electrophysiology, University of Dresden-Heart Center, Dresden, Germany
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
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Zhang JQ, Yu RH, Liang JB, Long DY, Sang CH, Ma CS, Dong JZ. Reconstruction left atrium and isolation pulmonary veins of paroxysmal atrial fibrillation using single contact force catheter with zero x-ray exposure: A CONSORT Study. Medicine (Baltimore) 2017; 96:e7726. [PMID: 29019873 PMCID: PMC5662296 DOI: 10.1097/md.0000000000007726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Conventional ablation of paroxysmal atrial fibrillation (PAF) is associated with radiation risks for patients and laboratory staff. Three-dimensional (3D) mapping system capable of showing contact force (CF) and direction of catheter tip may compensate for nonfluoroscopic safety issues. OBJECTIVE The aim of this study was to investigate the feasibility of zero x-ray exposure during reconstruction left atrium (LA) and ablation. METHODS Single, CF catheter, and 3D mapping system were used to reconstruct LA and isolate pulmonary veins (PV) in all patients. The patients were randomly divided into 2 groups after LA angiography. In group 1, reconstruction LA and isolation PV was performed with the help of 3D system (without x-ray), whereas in group 2, x-ray and 3D system were utilized to reconstruct LA and ablate PV antrum. After ablation, Lasso catheter was used to confirm the PV isolation. All patients were followed up to 12 months. RESULTS A total of 342 PAF patients were continuously enrolled. The basic clinical characteristics between the 2 groups had no significant difference. Parameters related to the procedure, average procedure time, ablation procedure time, average contact force (CF) applied, the percentage of time within CF settings, and average power applied during radiofrequency application showed no significant difference between the 2 groups. In group 1, the average fluoroscopy time before LA reconstruction was similar to that in group 2 (2.8 ± 0.4 vs. 2.4 ± 0.6 minutes, P = .75). The average fluoroscopy time during ablation was significantly lower than that in group 2 (0 vs. 7.6 ± 1.3 minutes, P < .001). The total x-ray exposure dose of the procedure in group 1 was significantly lower than that in group 2 (19.6 ± 9.4 vs. 128.7 ± 62.5 mGy, respectively, P < .001). Kaplan-Meier analysis indicated that there were no statistical differences in the probability of freedom from atrial arrhythmia (AF/AFL/AT) recurrence at 12 months between group 1 and group 2 (P = .152). The success rate after a single ablation procedure and without drugs (Class I/III AAD) at 12 months was not significantly different between the 2 groups (67.6%, 95% confidence interval [CI]: 62%-79.5% in group 1 and 68.9%, 95% CI: 63%-80.7% in group 2, P = .207). Procedural-related adverse events showed no significant different incidence between group 1 and group 2. A multivariate logistic regression analysis of risk factors was performed to evaluate the effectiveness outcome, which demonstrated that the percentage of CF (within the investigator-selected work ranges) during therapy was significantly associated with positive outcomes (odds ratio: 3.68; 95% CI: 1.65-10.6, P = .008), whereas the LA dimension was negatively associated with effectiveness outcomes (odds ratio: 0.72; 95% CI: 0.52-0.84, P = .016). CONCLUSIONS Reconstruction LA and isolation PV ablation using single CF-assisted catheter without x-ray exposure was both safe and effective. CF was positively associated with effective outcomes and LA dimensions negatively with effective ones.
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Affiliation(s)
- Jian Qiang Zhang
- Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai Beijing Anzhen Hospital, Capital Medical University, Beijing Juxian People Hospital, Shandong Province 276500,China
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Crowhurst J, Haqqani H, Wright D, Whitby M, Lee A, Betts J, Denman R. Ultra-low radiation dose during electrophysiology procedures using optimized new generation fluoroscopy technology. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:947-954. [PMID: 28618036 DOI: 10.1111/pace.13141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Electrophysiology procedures require fluoroscopic guidance, with the associated potentially adverse effects of ionizing radiation. Newer fluoroscopy systems have more features that enable dose-reduction strategies. This study aimed to investigate any reduction in radiation dose between an older fluoroscopy system (Philips Integris H5000, Philips Healthcare, Einhoven, Netherlands) and one of the latest systems (Siemens Artis Q, Siemens Healthcare, Erlangen, Germany), optimized with dose-reduction strategies. METHODS Radiation dose measures were collected over a 2-year period in a single electrophysiology laboratory. Procedures were separated into seven groups: devices, biventricular devices, electrophysiology studies, standard radiofrequency ablation, complex atrial ablation, ablation for ventricular arrhythmias, and pulmonary vein isolation. In the first year, an older fluoroscopy system was used, and in the second year, a new system, with dose reduction strategies. Comparisons were also made to the literature with regard to radiation dose levels. RESULTS Patient characteristics, fluoroscopy times, number of digital acquisitions, procedural times, and procedural success were largely similar between the old and new system across procedure groups. Overall dose area product (DAP) was reduced by 91% (5.0 [2.0-17.0] to 0.45 [0.16-2.61] Gycm2 [P > 0.001]) with the new system and was lower across all groups. DAP readings with the new system are some of the lowest published in the literature in all groups. CONCLUSION An optimized contemporary digital fluoroscopy system, with low radiation dose configuration and continued good procedural practice, can result in ultra-low radiation levels for all electrophysiology procedures, without compromising procedural time or procedural success.
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Affiliation(s)
- James Crowhurst
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland
| | - Haris Haqqani
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland
| | - Daniel Wright
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mark Whitby
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia.,Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston Queensland, Australia
| | - Adam Lee
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - John Betts
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Russell Denman
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
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BALLESTEROS GABRIEL, RAMOS ARDANAZ PABLO, NEGLIA RENZO, PALACIO SOLÍS MARCEL, DÍAZ FERNÁNDEZ CRISTINA, LÓPEZ GONZÁLEZ GRACIELA, JANIASHVILI ELENE, GARCÍA-BOLAO IGNACIO. Mediguide-Assisted Transseptal Puncture without Echocardiographic Guidance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:545-550. [DOI: 10.1111/pace.13039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - RENZO NEGLIA
- Cardiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | | | | | | | - ELENE JANIASHVILI
- Cardiology Department; Clínica Universidad de Navarra; Pamplona Spain
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Yamagata K, Aldhoon B, Kautzner J. Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation. Arrhythm Electrophysiol Rev 2016; 5:144-9. [PMID: 27617094 DOI: 10.15420/aer.2016.16.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy. During the procedure, fluoroscopy imaging is still considered essential to visualise catheters in real-time. However, radiation is often ignored by physicians since it is invisible and the long-term risks are underestimated. In this respect, it must be emphasised that radiation exposure has various potentially harmful effects, such as acute skin injury, malignancies and genetic disease, both to patients and physicians. For this reason, every electrophysiologist should be aware of the problem and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AF ablation procedures.
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Affiliation(s)
- Kenichiro Yamagata
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Bashar Aldhoon
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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27
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Development of radiation exposure in patients undergoing pulmonary vein isolation in Germany between 2007 and 2014: great potential to minimize radiation dosage. Clin Res Cardiol 2016; 105:858-64. [DOI: 10.1007/s00392-016-0994-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
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[Current state of treatment strategies for atrial fibrillation]. Herz 2016; 41:253-66; quiz 267-9. [PMID: 27067008 DOI: 10.1007/s00059-016-4413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Atrial fibrillation is the most common form of persistent cardiac arrhythmia with a greatly increasing prevalence due to an aging population and increasing cardiovascular risk factors. Apart from impairment of the quality of life atrial fibrillation is associated with a high morbidity, most importantly stroke and heart failure. The therapy is complex and aims at improving symptoms as well as the prevention of thromboembolic complications, heart failure and aggravating comorbidities. Based on individual patient characteristics and symptoms therapy is mainly based on heart rate control by pharmacological means or therapy for maintaining sinus rhythm. This treatment includes antiarrhythmic drugs and catheter ablation. Current research is aimed at the investigation of the electrophysiological mechanisms of recurrent therapy refractive atrial fibrillation and the question whether the maintenance of sinus rhythm can improve the prognosis of atrial fibrillation.
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Raju H, Whitaker J, Taylor C, Wright M. Electroanatomic Mapping and Transoesophageal Echocardiography for near Zero Fluoroscopy during Complex Left Atrial Ablation. Heart Lung Circ 2016; 25:652-60. [PMID: 26979468 DOI: 10.1016/j.hlc.2016.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND We evaluated Carto 3, transoesophageal echocardiography (TOE) and contact force (CF) sensing catheter in atrial fibrillation (AF) ablation. METHODS Unselected consecutive ablations performed under general anaesthesia (GA) were studied with modified protocol (cases, n=11) and compared to retrospective consecutive controls (n=10). Patent foramen ovale (PFO) or single transseptal puncture enabled left atrial (LA) access; ablation strategy was stepwise approach. Modified protocol utilised right atrial (RA) electrograms, CF and TOE to localise SmartTouch and create RA and CS electroanatomic map (EAM) without fluoroscopy. Transseptal puncture was performed with fluoroscopy in absence of PFO. Fluoroless pulmonary vein and LA EAM was created using TOE to locate circular-mapping catheter. RESULTS Mean age of cases was 57±11 years with 64% male compared with 60±11 (70% male) for controls. Patent foramen ovale was identified in four cases (36%) and two controls (20%). No early complications occurred. Shorter fluoroscopy time (median 36 vs 390seconds; p=0.038) and trend to lower radiation dose (median 17 vs 165 cGym2; p=0.053) was seen in cases, with no increase in total procedure time (p=0.438). CONCLUSIONS General anaesthesia, TOE and CF mapping catheters facilitate minimised fluoroscopy for catheter ablation of LA arrhythmias. Zero fluoroscopy is possible in a majority of cases with PFO.
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Affiliation(s)
| | - John Whitaker
- Cardiology Department, St Thomas' Hospital, London, UK
| | - Carly Taylor
- Cardiology Department, St Thomas' Hospital, London, UK
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Macle L, Thibault B, Andrade JG. Cardiac electrophysiology procedures guided by novel non-fluoroscopic catheter tracking systems. Expert Rev Med Devices 2016; 13:309-11. [PMID: 26878316 DOI: 10.1586/17434440.2016.1153969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Laurent Macle
- a Electrophysiology Service, Montreal Heart Institute and Department of Medicine , Université de Montréal , Montréal , Canada
| | - Bernard Thibault
- a Electrophysiology Service, Montreal Heart Institute and Department of Medicine , Université de Montréal , Montréal , Canada
| | - Jason G Andrade
- a Electrophysiology Service, Montreal Heart Institute and Department of Medicine , Université de Montréal , Montréal , Canada.,b Division of Cardiology, Department of Medicine , the University of British Columbia , Vancouver , Canada
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Bourier F, Reents T, Ammar-Busch S, Buiatti A, Kottmaier M, Semmler V, Telishevska M, Brkic A, Grebmer C, Lennerz C, Kolb C, Hessling G, Deisenhofer I. Evaluation of a new very low dose imaging protocol: feasibility and impact on X-ray dose levels in electrophysiology procedures. Europace 2015; 18:1406-10. [PMID: 26589627 PMCID: PMC5400031 DOI: 10.1093/europace/euv364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022] Open
Abstract
Aims This study presents and evaluates the impact of a new lowest-dose fluoroscopy protocol (Siemens AG), especially designed for electrophysiology (EP) procedures, on X-ray dose levels. Methods and results From October 2014 to March 2015, 140 patients underwent an EP study on an Artis zee angiography system. The standard low-dose protocol was operated at 23 nGy (fluoroscopy) and at 120 nGy (cine-loop), the new lowest-dose protocol was operated at 8 nGy (fluoroscopy) and at 36 nGy (cine-loop). Procedural data, X-ray times, and doses were analysed in 100 complex left atrial and in 40 standard EP procedures. The resulting dose–area products were 877.9 ± 624.7 µGym² (n = 50 complex procedures, standard low dose), 199 ± 159.6 µGym² (n = 50 complex procedures, lowest dose), 387.7 ± 36.0 µGym² (n = 20 standard procedures, standard low dose), and 90.7 ± 62.3 µGym² (n = 20 standard procedures, lowest dose), P < 0.01. In the low-dose and lowest-dose groups, procedure times were 132.6 ± 35.7 vs. 126.7 ± 34.7 min (P = 0.40, complex procedures) and 72.3 ± 20.9 vs. 85.2 ± 44.1 min (P = 0.24, standard procedures), radiofrequency (RF) times were 53.8 ± 26.1 vs. 50.4 ± 29.4 min (P = 0.54, complex procedures) and 10.1 ± 9.9 vs. 12.2 ± 14.7 min (P = 0.60, standard procedures). One complication occurred in the standard low-dose and lowest-dose groups (P = 1.0). Conclusion The new lowest-dose imaging protocol reduces X-ray dose levels by 77% compared with the currently available standard low-dose protocol. From an operator standpoint, lowest X-ray dose levels create a different, reduced image quality. The new image quality did not significantly affect procedure or RF times and did not result in higher complication rates. Regarding radiological protection, operating at lowest-dose settings should become standard in EP procedures.
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Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Sonia Ammar-Busch
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Alessandra Buiatti
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Christof Kolb
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, München 80636, Germany
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Giaccardi M, Del Rosso A, Guarnaccia V, Ballo P, Mascia G, Chiodi L, Colella A. Near-zero x-ray in arrhythmia ablation using a 3-dimensional electroanatomic mapping system: A multicenter experience. Heart Rhythm 2015; 13:150-6. [PMID: 26341606 DOI: 10.1016/j.hrthm.2015.09.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radiation exposure related to conventional tachyarrhythmia radiofrequency catheter ablation (RFCA) carries small but not negligible stochastic and deterministic effects on health. These effects are cumulative and potentially more harmful in younger individuals. Nonfluoroscopic mapping systems can significantly reduce the radiological exposure and in some cases it can completely eliminate it. OBJECTIVE The aim of this study was to assess the safety, feasibility, and efficacy of a complete nonfluoroscopic approach for RFCA compared with ablation procedures performed under fluoroscopic guidance. METHODS RFCA was performed in 442 consecutive patients (mean age 58 ± 19 years). The first 145 patients (group 1) were treated only under fluoroscopic guidance, and the following 297 patients (group 2) were treated using a nonfluoroscopic electroanatomic mapping system (EnSite Velocity). RFCA was completely performed without fluoroscopy in 255 of 297 patients in group 2 (86%). RESULTS The acute success rate did not differ between group 1 and group 2 (97% vs 96%; P = .46), and there were no differences in either procedure time (87 ± 57 minutes vs 91 ± 52 minutes; P = .41) or complication rate. Fluoroscopic exposure in group 2 was significantly reduced in comparison with group 1 (14 ± 6 seconds vs 1159 ± 833 seconds; P < .0001). CONCLUSION Compared with the conventional fluoroscopic technique, the near-zero radiation (RX) approach provides similar outcomes and may significantly reduce or eliminate ionizing radiation exposure in RFCA. These reductions are achieved without altering the duration or compromising the safety and effectiveness of the procedure.
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Affiliation(s)
- Marzia Giaccardi
- Electrophysiology Unit, Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy.
| | - Attilio Del Rosso
- Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Vincenzo Guarnaccia
- Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Giuseppe Mascia
- Cardiology Unit, Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy
| | - Leandro Chiodi
- Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Andrea Colella
- Electrophysiology Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy
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Wright M, Narayan SM. Ablation of atrial fibrillation. Trends Cardiovasc Med 2015; 25:409-19. [PMID: 25572010 PMCID: PMC4764083 DOI: 10.1016/j.tcm.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 01/08/2023]
Abstract
Ablation is increasingly used to treat AF, since recent trials of pharmacological therapy for AF have been disappointing. Ablation has been shown to improve maintenance of sinus rhythm compared to pharmacological therapy in many multicenter trials, although success rates remain suboptimal. This review will discuss several trends in the field of catheter ablation, including studies to advance our understanding of AF mechanisms in different patient populations, innovations in detecting and classifying AF, use of this information to improve strategies for ablation, technical innovations that have improved the ease and safety of ablation, and novel approaches to surgical therapy and imaging. These trends are likely to further improve results from AF ablation in coming years as it becomes an increasingly important therapeutic option for many patients.
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Affiliation(s)
- Matthew Wright
- BHF Centre of Excellence, London, UK; Division of Imaging Sciences and Biomedical Engineering, King׳s College London, King׳s Health Partners, St. Thomas׳ Hospital, London, UK
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Sommer P, Kircher S, Rolf S, Richter S, Doering M, Arya A, Bollmann A, Hindricks G. Non-fluoroscopic catheter tracking for fluoroscopy reduction in interventional electrophysiology. J Vis Exp 2015:e52606. [PMID: 26066541 PMCID: PMC4542975 DOI: 10.3791/52606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab. Furthermore, in a subset of indications such as supraventricular tachycardias, NFCV enables a fully non-fluoroscopic procedure and allows the lab staff to work without wearing lead aprons. With this protocol, we demonstrate that even complex procedures such as ablations of atrial fibrillation, that are typically associated with fluoroscopy times of >30 min in conventional settings, can safely be performed with a reduction of >90% in fluoroscopy exposure by the additional use of NFCV.
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Affiliation(s)
- Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig;
| | - Simon Kircher
- Department of Electrophysiology, Heart Center, University of Leipzig
| | - Sascha Rolf
- Department of Electrophysiology, Heart Center, University of Leipzig
| | - Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig
| | - Micha Doering
- Department of Electrophysiology, Heart Center, University of Leipzig
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig
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Akbulak RÖ, Schäffer B, Jularic M, Moser J, Schreiber D, Salzbrunn T, Meyer C, Eickholt C, Kuklik P, Hoffmann BA, Willems S. Reduction of Radiation Exposure in Atrial Fibrillation Ablation Using a New Image Integration Module: A Prospective Randomized Trial in Patients Undergoing Pulmonary Vein Isolation. J Cardiovasc Electrophysiol 2015; 26:747-53. [PMID: 25807878 DOI: 10.1111/jce.12673] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 02/23/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recently, a new image integration module (IIM, CartoUnivu™ Module) has been introduced to combine and merge fluoroscopy images with 3-dimensional-(3D)-electroanatomical maps (Carto® 3 System) into an accurate 3D view. The aim of the study was to investigate the influence of IIM on the fluoroscopy exposure during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial. METHODS AND RESULTS Between June and November 2014, a total of 60 patients with PAF (73.3% male, 64.0 ± 9.2 years), who underwent PVI with the endpoint of unexcitability of the ablation line, were randomized to either a conventional 3D mapping system (Carto® 3 System) or to an additional IIM on the basis of an assumed reduction of fluoroscopy exposure by the use of IIM. There were no significant differences in baseline characteristics. The median ablation procedure time was identical in both groups (140.7 ± 27.8 minutes vs. 140.8 ± 39.5 minutes; P = 0.851). A significant decrease of mean fluoroscopy time from 11.9 ± 2.1 to 7.4 ± 2.6 minutes (P < 0.0006) and median fluoroscopy dose from 882.9 to 476.5 cGycm(2) (P < 0.001) was achieved. The main reduction of radiation could be realized during creation of the 3D-map. No major complications occurred during the procedures. After a median follow-up of 125.7 ± 45.6 days 80% of the patients were free from any atrial arrhythmias. CONCLUSION CartoUnivu™ module easily integrates into the workflow of PVI with the endpoint of unexcitability of the ablation line without prolonging the procedure time. It is associated with a marked reduction in fluoroscopic dose when compared to a conventional 3D mapping system.
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Affiliation(s)
- Ruken Özge Akbulak
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Schäffer
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Moser
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Doreen Schreiber
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Salzbrunn
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Kuklik
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology - Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Wielandts JY, De Buck S, Michielsen K, Louw R, Garweg C, Nuyts J, Ector J, Maes F, Heidbuchel H. Multi-phase rotational angiography of the left ventricle to assist ablations: feasibility and accuracy of novel imaging. Eur Heart J Cardiovasc Imaging 2015; 17:162-8. [PMID: 26003152 DOI: 10.1093/ehjci/jev120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/15/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Interventional left ventricular (LV) procedures integrating static 3D anatomy visualization are subject to mismatch with dynamic catheter movements due to prominent LV motion. We aimed to evaluate the accuracy of a recently developed acquisition and post-processing protocol for low radiation dose LV multi-phase rotational angiography (4DRA) in patients. METHODS AND RESULTS 4DRA image acquisition of the LV was performed as investigational acquisition in patients undergoing left-sided ablation (11 men; BMI = 24.7 ± 2.5 kg/m²). Iodine contrast was injected in the LA, while pacing from the RA at a cycle length of 700 ms. 4DRA acquisition and reconstruction were possible in all 11 studies. Reconstructed images were post-processed using streak artefact reduction algorithms and an interphase registration-based filtering method, increasing contrast-to-noise ratio by a factor 8.2 ± 2.1. This enabled semi-automatic segmentation, yielding LV models of five equidistant phases per cardiac cycle. For evaluation, off-line 4DRA fluoroscopy registration was performed, and the 4DRA LV contours of the different phases were compared with the contours of five corresponding phases of biplane LV angiography, acquired in identical circumstances. Of the distances between these contours, 95% were <4 mm in both incidences. Effective radiation dose for 4DRA, calculated by patient-specific Monte-Carlo simulation, was 5.1 ± 1.1 mSv. CONCLUSION Creation of 4DRA LV models in man is feasible at near-physiological heart rate and with clinically acceptable radiation dose. They showed high accuracy with respect to LV angiography in RAO and LAO. The presented technology not only opens perspectives for full cardiac cycle dynamic anatomical guidance during interventional procedures, but also for 3DRA without need for very rapid pacing.
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Affiliation(s)
- Jean-Yves Wielandts
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium
| | - Stijn De Buck
- Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Electrical Engineering, ESAT/PSI, Medical Image Computing, KU Leuven, Leuven, Belgium
| | - Koen Michielsen
- Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Ruan Louw
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Johan Nuyts
- Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Frederik Maes
- Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Electrical Engineering, ESAT/PSI, Medical Image Computing, KU Leuven, Leuven, Belgium iMinds-Future Health Department, KU Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Hasselt University and Heart Center Hasselt, Diepenbeek, Belgium
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Huo Y, Christoph M, Forkmann M, Pohl M, Mayer J, Salmas J, Sitzy J, Wunderlich C, Piorkowski C, Gaspar T. Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study. Heart Rhythm 2015; 12:1945-55. [PMID: 26001508 DOI: 10.1016/j.hrthm.2015.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We explored whether the use of a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping (F-EAM) system could result in a reduction of overall fluoroscopy time and radiation doses during the whole procedure of atrial fibrillation (AF) ablation. METHODS Eighty patients (44 men (55%); mean age 63 ± 10 years) who underwent catheter ablation due to paroxysmal AF were recruited consecutively in the present study. Patients were randomized (1:1) into 2 arms for AF ablation: one using a conventional 3-dimensional electroanatomical mapping (EAM) system and the other using the F-EAM system. RESULTS Fluoroscopy time (10:42 [interquartile range {IQR} 8:45-12:46] minutes:seconds vs 1:45 [IQR 1:05-2:22] minutes:seconds; P < .001) and radiation doses (2440 [IQR 1593-3091] cGy·cm(2) vs 652 [IQR 326-1489] cGy·cm(2); P < .001) in the EAM group were significantly greater than those in the F-EAM group. The majority of reduction of radiation exposure was achieved after transseptal puncture, which was near-zero fluoroscopic exposure. In total, approximately 84% of fluoroscopy time and 73% of radiation doses have been reduced during the AF ablation procedure using the F-EAM system compared to using the conventional EAM system. However, procedure time did not differ significantly (1:39 [IQR 1:18-2:10] hours:minutes vs 1:37 [IQR 1:17-1:50] hours:minutes; P = .362). During follow-up (5.9 ± 1.3 months), 61 patients (76.3%) had no recurrence of atrial arrhythmias. The recurrence rate between the 2 groups did not differ. CONCLUSION AF catheter ablation using the F-EAM system was safe and resulted in a significant reduction of radiation exposure to patients and staff without complicating the workflow of the procedure. A near-zero fluoroscopic catheter ablation procedure could be performed without compromising acute/mid-term efficacy and safety.
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Affiliation(s)
- Yan Huo
- Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany; Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
| | - Marian Christoph
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Mathias Forkmann
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Matthias Pohl
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Julia Mayer
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Jozef Salmas
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Judith Sitzy
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Carsten Wunderlich
- Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Christopher Piorkowski
- Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany; Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
| | - Thomas Gaspar
- Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany; Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany
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CANO ÓSCAR, ALONSO PAU, OSCA JOAQUÍN, ANDRÉS ANA, SANCHO-TELLO MARÍAJOSÉ, OLAGÜE JOSÉ, SALVADOR ANTONIO, MARTÍNEZ-DOLZ LUIS. Initial Experience with a New Image Integration Module Designed for Reducing Radiation Exposure During Electrophysiological Ablation Procedures. J Cardiovasc Electrophysiol 2015; 26:662-70. [DOI: 10.1111/jce.12659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- ÓSCAR CANO
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Instituto Investigación Sanitaria La Fe; Valencia Spain
| | - PAU ALONSO
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Instituto Investigación Sanitaria La Fe; Valencia Spain
| | - JOAQUÍN OSCA
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ANA ANDRÉS
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Instituto Investigación Sanitaria La Fe; Valencia Spain
| | - MARÍA-JOSÉ SANCHO-TELLO
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - JOSÉ OLAGÜE
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ANTONIO SALVADOR
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - LUIS MARTÍNEZ-DOLZ
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
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Mansour M, Afzal MR, Gunda S, Pillarisetti J, Heist K, Acha MR, Heard M, Ruskin J, Lakkireddy D. Feasibility of Transseptal Puncture Using a Nonfluoroscopic Catheter Tracking System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:791-6. [PMID: 25712806 DOI: 10.1111/pace.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access. METHODS The feasibility of performing TS puncture with MediGuide (MDG) was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation for atrial fibrillation. These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups. RESULTS All patients underwent successful TS puncture. Fluoroscopy time for double TS puncture using the MDG system was significantly lower than the control group (0.48 ± 0.17 minutes vs. 5.9 ± 0.65 minutes; P < 0.0001). No major complications occurred during the procedures in either group. CONCLUSIONS TS puncture can be successfully performed using MDG, and results in significant reduction in radiation exposure.
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Affiliation(s)
- Moussa Mansour
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Muhammad R Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Sampath Gunda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Jayasree Pillarisetti
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Moshe Rav Acha
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jeremy Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
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41
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MALLIET NICOLAS, ANDRADE JASONG, KHAIRY PAUL, NGUYEN THANH HIENKIEM, VENIER SANDRINE, DUBUC MARC, DYRDA KATIA, GUERRA PETER, MONDÉSERT BLANDINE, RIVARD LÉNA, TADROS RAFIK, TALAJIC MARIO, THIBAULT BERNARD, ROY DENIS, MACLE LAURENT. Impact of a Novel Catheter Tracking System on Radiation Exposure during the Procedural Phases of Atrial Fibrillation and Flutter Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:784-90. [DOI: 10.1111/pace.12611] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 02/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- NICOLAS MALLIET
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - JASON G. ANDRADE
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
- Department of Medicine; The University of British Columbia; Vancouver Canada
| | - PAUL KHAIRY
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - HIEN KIEM NGUYEN THANH
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - SANDRINE VENIER
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - MARC DUBUC
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - KATIA DYRDA
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - PETER GUERRA
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - BLANDINE MONDÉSERT
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - LÉNA RIVARD
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - RAFIK TADROS
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - MARIO TALAJIC
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - BERNARD THIBAULT
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - DENIS ROY
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - LAURENT MACLE
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
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Schoene K, Rolf S, Schloma D, John S, Arya A, Dinov B, Richter S, Bollmann A, Hindricks G, Sommer P. Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study. Europace 2015; 17:1117-21. [PMID: 25736724 DOI: 10.1093/europace/euu398] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/15/2014] [Indexed: 11/12/2022] Open
Abstract
AIMS Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter. METHODS AND RESULTS We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P < 0.001). This resulted in a significant reduction in radiation dose in patients randomized to NFCT [17.4 (IQR 11; 206.6) cGy cm(2)] vs. the CONV group [418.4 (IQR 277; 812.2) cGy cm(2)] (P < 0.001). There were no significant differences in procedure duration between the NFCT group [49.5 (IQR 37; 65) min] when compared with the CONV group [33.5 (IQR 26.3; 55.5) min] (P = 0.053). No adverse events were recorded. Freedom from atrial flutter at 6 months of follow-up was 19/20 (95%) in the NFCT and 18/20 (90%) in the CONV group (n.s.). CONCLUSION In this first prospective randomized study, by comparing NFCT with standard fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use.
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Affiliation(s)
- Katharina Schoene
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Sascha Rolf
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Denis Schloma
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Silke John
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Arash Arya
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Borislav Dinov
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Sergio Richter
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Gerhard Hindricks
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Philipp Sommer
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
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Rolf S, Hindricks G, Sommer P, Richter S, Arya A, Bollmann A, Kosiuk J, Koutalas E. Electroanatomical mapping of atrial fibrillation: Review of the current techniques and advances. J Atr Fibrillation 2014; 7:1140. [PMID: 27957132 PMCID: PMC5135200 DOI: 10.4022/jafib.1140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 01/07/2023]
Abstract
The number of atrial fibrillation (AF) catheter ablations performed annually has been increasing exponentially in the western countries in the last few years. This is clearly related to technological advancements, which have greatly contributed to the improvements in catheter ablation of AF. In particular, state-of-the-art electroanatomical mapping systems have greatly facilitated mapping processes and have enabled complex AF ablation strategies. In this review, we outline contemporary and upcoming electroanatomical key technologies focusing on new mapping tools and strategies in the context of AF catheter ablation.
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Affiliation(s)
- Sascha Rolf
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gerhard Hindricks
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Philipp Sommer
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Richter
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Arash Arya
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andreas Bollmann
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Jedrzej Kosiuk
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Emmanuel Koutalas
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
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44
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Affiliation(s)
- John D Ferguson
- From the Cardiology Division, Department of Medicine, University of Virginia Medical Center, Charlottesville.
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