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Bertini M, Pompei G, Tolomeo P, Malagù M, Fiorio A, Balla C, Vitali F, Rapezzi C. Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation. BIOLOGY 2021; 10:biology10121333. [PMID: 34943247 PMCID: PMC8698328 DOI: 10.3390/biology10121333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
Abstract
Simple Summary Electrophysiological procedures are mainly performed using fluoroscopy, exposing both healthcare staff and patients to a non-negligible dose of radiation. To date, simple ablation procedures have often been approached with zero fluoroscopy. In complex ablation procedures, such as atrial fibrillation (AF) ablation, zero fluoroscopy is still challenging mainly because of transseptal puncture. We report a workflow to perform a complete zero-fluoroscopy AF ablation using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath visible on the mapping system. We describe two cases, one with paroxysmal AF and the other with persistent AF during which this novel workflow was successfully applied with complete zero-fluoroscopy exposure and achieving pulmonary vein isolation. Abstract Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.
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Affiliation(s)
- Matteo Bertini
- Correspondence: ; Tel.: +39-0532236269; Fax: +39-0532236593
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Siebermair J, Neumann B, Risch F, Riesinger L, Vonderlin N, Koehler M, Lackermaier K, Fichtner S, Rizas K, Sattler SM, Sinner MF, Kääb S, Estner HL, Wakili R. High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation - Two-year clinical outcome of a single center experience. Sci Rep 2019; 9:8830. [PMID: 31222008 PMCID: PMC6586935 DOI: 10.1038/s41598-019-45115-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age- and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 ± 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 ± 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 ± 10.6 vs. 29.8 ± 13.4 min; p < 0.01) and total radiation dose (866.0 ± 1003.3 vs. 1731.2 ± 1978.4 cGy; p < 0.01) compared to the COM group. HDM was equivalent but not superior to COM with respect to clinical outcome after PVI and resulted in reduced fluoroscopy time and radiation exposure. These results suggest that HDM-guided PVI is effective and safe for AF ablation. Potential benefits in comparison to conventional mapping systems, e.g. arrhythmia recurrence rates, have to be addressed in randomized trials.
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Affiliation(s)
- J Siebermair
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - B Neumann
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - F Risch
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - L Riesinger
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - N Vonderlin
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - M Koehler
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - K Lackermaier
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - S Fichtner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - K Rizas
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - S M Sattler
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - S Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - H L Estner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - R Wakili
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany. .,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany. .,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
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