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Safiullina AA, Uskach TM, Sapelnikov OV, Saidova MA, Ansheles AA, Sergienko VB, Amanatova VA, Grishin IR, Cherkashin DI, Akchurin RS, Tereschenko SN. [Improvement of the technique of positioning the endocardial electrodes of the cardiac contractility modulation device in patients with CHF with reduced ejection fraction and atrial fibrillation]. TERAPEVT ARKH 2024; 96:675-682. [PMID: 39106510 DOI: 10.26442/00403660.2024.07.202782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/28/2024] [Indexed: 08/09/2024]
Abstract
AIM To evaluate the efficacy and safety of the advanced technique for positioning the endocardial electrodes of a cardiac contractility modulation (CCM) device. MATERIALS AND METHODS The CCM system was implanted in 100 patients, of which 60 CCM electrodes were positioned in the most optimal zones of myocardial perfusion, in particular, in the zone of the minor focal-scar/fibrotic lesion (the Summed Rest Score of 0 to 1-2, the intensity of the radiopharmaceutical at least 30%), and in 40 patients according to the standard procedure. Before the implantation of the CCM system, 60 patients underwent tomography (S-SPECT) of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest to determine the most optimal electrode positioning zones and 100 patients underwent transthoracic echocardiography at baseline and after 12 months to assess the effectiveness of surgical treatment. RESULTS Improved ventricular electrode positioning technique is associated with the best reverse remodeling of the left ventricular myocardium, especially in patients with ischemic chronic heart failure, with less radiation exposure to the surgeon and the patient, and without electrode-related complications. CONCLUSION At the preoperative stage, it is recommended to perform a synchronized single-photon emission computed tomography of the myocardium with 99mTc-methoxy-isobutyl-isonitrile at rest before implantation of the CCM device to assess the presence of scar zones/myocardial fibrosis in the anterior and inferior septal regions of the interventricular septum of the left ventricle, followed by implantation of ventricular electrodes in the zone of the minor scar/fibrous lesion, which will allow to achieve optimal stimulation parameters, increase the effectiveness of CCM therapy, reduce the radiation exposure on medical personnel and the patient during surgery.
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Affiliation(s)
| | - T M Uskach
- Chazov National Medical Research Center of Cardiology
| | | | - M A Saidova
- Chazov National Medical Research Center of Cardiology
| | - A A Ansheles
- Chazov National Medical Research Center of Cardiology
| | - V B Sergienko
- Chazov National Medical Research Center of Cardiology
| | - V A Amanatova
- Chazov National Medical Research Center of Cardiology
| | - I R Grishin
- Chazov National Medical Research Center of Cardiology
| | | | - R S Akchurin
- Chazov National Medical Research Center of Cardiology
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Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, Paolucci M, Mazzone P, Guarracini F. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics (Basel) 2024; 14:182. [PMID: 38248058 PMCID: PMC10814721 DOI: 10.3390/diagnostics14020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias' ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
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Affiliation(s)
- Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Eleonora Bonvicini
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Elena Coradello
- Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
| | - Alessio Testoni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Carbonaro
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Giulia Colombo
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Marco Paolucci
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
| | - Fabrizio Guarracini
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy (M.C.); (P.M.)
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Iqbal AM, Li KY, Mahmood M, Gautam S. Safety of fluoroless radiofrequency catheter ablation for atrial fibrillation in patients with pre-existing cardiac implantable electronic device: A single-center study. Pacing Clin Electrophysiol 2023; 46:1387-1392. [PMID: 37713192 DOI: 10.1111/pace.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/27/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFA) for atrial fibrillation (AF) is being increasingly performed without fluoroscopy. This study aims to determine the safety of fluoroless RFA for patients with pre-existing cardiac implantable electronic devices (CIED). METHODS This is a single-center, single-operator, retrospective, observational study of 225 consecutive fluoroless RFA procedures for AF from June 1, 2019 to June 1, 2022. All procedures were performed with intracardiac echocardiography (ICE) support. Patients with pre-existing CIED were extracted from the database. Each CIED was interrogated at the start and end of each procedure and at 30-day follow-up. Pre- and post-procedure CIED interrogations were compared for any change in device or lead parameters. Patients were tracked for any subsequent device malfunction. RESULTS Out of 225 fluoroless AF ablations, 25 (10.2%) had pre-existing CIED (14 dual-chamber pacemakers, three dual-chamber defibrillators, three single-chamber defibrillators, one single chamber pacemaker, and four biventricular devices). Mean patient age was 71 ± 6 years. The mean duration of indwelling CIED was 1804 ± 1645 days (range: 78-6267 days). One (4%) patient had lead-related fibrin on ICE imaging. There was no significant difference in lead(s) threshold, impedance, or sensing post procedure or at 30-day follow-up compared to pre procedure. None of the patients required lead revision. There were no intra- or post-op thromboembolic events or subsequent device infection. One patient underwent CIED extraction after 11 months for an unrelated secondary device infection. CONCLUSIONS Radiofrequency catheter ablation for AF can be safely performed without fluoroscopy in patients with pre-existing CIED.
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Affiliation(s)
- Arshad Muhammad Iqbal
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kai Yu Li
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Mobasser Mahmood
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandeep Gautam
- Department of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
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Kostova-Lefterova DZ, Shalganov TN, Stoyanov MK, Traykov VB, Boychev DB, Protich MM, Bonev NB. Proposing national diagnostic reference levels for electrophysiology studies and catheter ablation procedures in Bulgaria. Phys Med 2023; 108:102572. [PMID: 36989978 DOI: 10.1016/j.ejmp.2023.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION The implementation of diagnostic reference levels (DRLs) is an essential tool for optimisation of the routine practice, better management of patient exposure while maintaining sufficient image quality. National DRLs for electrophysiology (EP) procedures are not available in our country. PURPOSE The main purpose of the study was to propose, for first time in Bulgaria, national DRLs (NDRLs) for EP studies and ablation procedures of two different levels of complexity. The proposed DRLs can be later used to establish NDRLs by the national authority with regulatory functions related to medical exposure. METHOD A retrospective study was done with the three highest volume Bulgarian EP centers, where over 95% of all cardiac ablations were performed. Data were extracted from the electronic registry for invasive electrophysiology BG-EPHY. Independently of the proposed NDRLs, we also compared the air kerma-area product (KAP) between the participating centers for procedures of the same level of complexity. RESULTS The proposed NDRL in terms of KAP were: 5.2 Gy.cm2 for diagnostic EP studies, 25.5 Gy.cm2 for simple ablations, and 52.1 Gy.cm2 for complex ablations. There was a significant variation in KAP for procedures with the same degree of complexity within each center. CONCLUSION This study is the first to propose NDLRs for EP studies and ablation procedures of two levels of complexity in Bulgaria. The results identified EP procedures requiring further optimization of patient protection and provided a basis for future comparisons and standardization with further investigations on the topic. The proposed NDRLs are recommended to be used for better management of radiation exposure during EP procedures of different levels of complexity.
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Schmidt EJ, Elahi H, Meyer ES, Baumgaertner R, Neri L, Berger RD, Tandri H, Hunter DW, Cohen SP, Oberdier MT, Halperin HR. Reduced Motion External Defibrillation (RMD): Reduced Subject Motion with Equivalent Defibrillation Efficiency validated in Swine. Heart Rhythm 2022; 19:1165-1173. [PMID: 35240311 DOI: 10.1016/j.hrthm.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND External defibrillators are used for arrhythmia cardioversion and for defibrillating during cardiac arrest. During defibrillation, short-duration Biphasic pulses cause intense motion due to rapid chest-wall muscle contraction. A reduced-motion external defibrillator (RMD) was constructed by integrating a commercial defibrillator with a Tetanizing-waveform generator. A long-duration low-amplitude Tetanizing-waveform slowly stimulated the chest musculature prior to the Biphasic pulse, reducing muscle contraction during the shock. OBJECTIVE Evaluate RMD defibrillation in swine for subject-motion during defibrillation pulses and for defibrillation effectiveness. RMD defibrillation can reduce the duration of arrhythmia ablation-therapy or simplify cardioversion procedures. METHODS The Tetanizing unit delivered a triangular 1-kHz pulse of 0.25-2.0sec duration and 10-100Volt peak amplitude, subsequently triggering the conventional defibrillator to output standard 1-200J energy Biphasic pulses at the next R-wave. Forward-limb motion was evaluated by measuring Peak Acceleration and Limb Work during RMD (Tetanizing+Biphasic) or Biphasic-pulse-only waveforms at 10-3sec sampling-rate. Seven swine were arrested electrically and subsequently defibrillated. Biphasic-pulse-only and RMD defibrillations were repeated 25-35 times/swine, varying Tetanizing parameters and the Biphasic-pulse energy. Defibrillation thresholds (DFTs) were established by measuring the minimum energy required to restore sinus-rhythm with Biphasic-pulse-only or RMD defibrillations. RESULTS Two forward-limb acceleration-peaks occurred during both the Tetanizing-waveform and Biphasic-pulse, indicating rapid and slower nociceptic (pain-sensation) nerve-fiber activation. Optimal RMD Tetanizing-parameters (25-35V, 0.25-0.75sec duration), relative to Biphasic-pulse-only defibrillations, resulted in 74+10% smaller Peak Accelerations and 85+10% reduced Limb Work. DFT energies were identical, comparing RMD to Biphasic-pulse-only defibrillations. CONCLUSION Relative to conventional defibrillations, RMD defibrillations maintain rhythm-restoration efficiency with drastically reduced subject-motion.
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Affiliation(s)
- Ehud J Schmidt
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD.
| | - Hassan Elahi
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | - Eric S Meyer
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | | | - Luca Neri
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | - Ronald D Berger
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | | | - David W Hunter
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | | | - Matt T Oberdier
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
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Zagrodzky J, Bailey S, Shah S, Kulstad E. Impact of Active Esophageal Cooling on Fluoroscopy Usage During Left Atrial Ablation. J Innov Card Rhythm Manag 2021; 12:4749-4755. [PMID: 34676132 PMCID: PMC8519316 DOI: 10.19102/icrm.2021.121101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022] Open
Abstract
Risks to collateral structures exist with radiofrequency (RF) ablation of the left atrium to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation. Passive luminal esophageal temperature (LET) monitoring is commonly utilized, but increasing data suggest limited benefits with LET monitoring. In contrast, active cooling of the esophagus has been shown to significantly reduce esophageal injury. Active cooling of the esophagus also avoids the need for stopping and repositioning an LET probe during use, which may reduce the need for fluoroscopy use. This study aimed to measure the impact on fluoroscopy use during RF ablation with esophageal cooling using a dedicated cooling device in a low-fluoroscopy practice. All patients who underwent PVI over a one-year timeframe by a single provider were analyzed. Patients undergoing PVI prior to the incorporation of an esophageal cooling protocol into standard ablation practice were treated with traditional LET monitoring. Patients treated after this point received active esophageal cooling, in which no LET monitoring is utilized. A total of 280 patients were treated; 91 patients were treated using LET monitoring, and 189 patients were treated with esophageal cooling. The mean total fluoroscopy time before the implementation of the esophageal cooling protocol in 91 patients was 194 seconds [standard deviation (SD): 182 seconds] per case, with a median of 144 seconds. The mean total fluoroscopy time after implementation in 189 patients was 126 seconds (SD: 120 seconds) per case with a median of 96 seconds, representing a reduction of 35% per case (p < 0.0001, Mann-Whitney U test). In this largest study to date of active esophageal cooling during PVI, a 35% reduction in fluoroscopy time compared with patients who received LET monitoring was found. This reduction was seen despite an already low fluoroscopy usage rate in place.
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Affiliation(s)
- Jason Zagrodzky
- Department of Electrophysiology, St. David’s South Austin Medical Center, Austin, TX, USA
| | - Shane Bailey
- Department of Electrophysiology, St. David’s South Austin Medical Center, Austin, TX, USA
| | | | - Erik Kulstad
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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Cioffi GM, Gasperetti A, Tersalvi G, Schiavone M, Compagnucci P, Sozzi FB, Casella M, Guerra F, Dello Russo A, Forleo GB. Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives. J Cardiovasc Electrophysiol 2021; 32:3082-3094. [PMID: 34570400 DOI: 10.1111/jce.15255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young-adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives.
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Affiliation(s)
- Giacomo M Cioffi
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy.,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy.,Department of Cardiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Fabiola B Sozzi
- Department of Cardiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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Percell RL, Pike JL, Olmsted RK, Beideck JE, Nunes HL, Johnson KN, Schaffer M, Vachok LB, Sveen SM, Keim EJ, Mohr-Burt SO, Saalfeld RM, Beran CA, Allison TW, Stock JF. The Grand SANS FLUORO (SAy No Series to FLUOROsopy) Study: Examining Fluoroscopy Use in More than 1,000 Ablation Procedures. J Innov Card Rhythm Manag 2020; 11:4224-4232. [PMID: 32983591 PMCID: PMC7510468 DOI: 10.19102/icrm.2020.1100903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The majority of electrophysiologists routinely use fluoroscopy (FLUORO) during ablation procedures for common arrhythmias despite the known complications of radiation exposure and protective lead use. This study assessed the safety of catheter ablation (CA) with FLUORO versus without FLUORO (SANS FLUORO) in patients with the following common arrhythmias: atrial fibrillation (AF), atrial flutter, supraventricular tachycardia, and ventricular tachycardia. A total of 1,258 CA procedures were performed in 816 consecutive patients over a 53-month period (SANS FLUORO CA: 609 patients; FLUORO CA: 209 patients). The secondary outcome was the efficacy of AF ablation in FLUORO versus SANS FLUORO patients. Ultimately, there was no statistically significant difference found concerning the safety of CA in the SANS FLUORO and FLUORO groups in terms of procedure time, vascular complications, tamponade, stroke, or death. FLUORO patients had markedly increased FLUORO time, increased radiation exposure, and increased dose-area product (all p < 0.0001). AF development after SANS FLUORO CA of AF was not different from that after FLUORO CA regardless of the pulmonary vein isolation (PVI) modality used (cryoablation versus radiofrequency) at 24 months (p = 0.21). Additionally, women fared just as well as men after CA ablation for AF. At 36 months, 58% of SANS FLUORO AF device patients were free from AF. As such, SANS FLUORO CA of common arrhythmias appears to be as safe as FLUORO CA but with a markedly reduced level of radiation exposure. Also, SANS FLUORO CA remains as effective as FLUORO CA in the prevention of AF for up to 24 months.
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Affiliation(s)
- Robert L Percell
- SANS FLUORO Institute, Electrophysiology Department, Bryan Heart Institute, Lincoln, NE, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Casey A Beran
- Abbott Medical, Abbott Laboratories, Abbott Park, IL, USA
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Salam T, Wilson L, Bohannan S, Morin M. Safety and Effectiveness of a Novel Fluoroless Transseptal Puncture Technique for Lead-free Catheter Ablation: A Case Series. J Innov Card Rhythm Manag 2020; 11:4079-4085. [PMID: 32368383 PMCID: PMC7192152 DOI: 10.19102/icrm.2020.110405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/28/2019] [Indexed: 01/07/2023] Open
Abstract
Increasing awareness of the health risks associated with the exposure of patients and staff in the catheterization laboratory to radiation has encouraged the pursuit of efforts to reduce the use of fluoroscopy during catheter ablation procedures. Although nonfluoroscopic guidance of ablation catheters has been previously described, transseptal access is still perceived as the last remaining barrier to completely fluoroless ablations. This study examined the safety and effectiveness of transseptal puncture and radiofrequency (RF) catheter ablation using a completely fluoroless approach. Three hundred eighty-two consecutive cases that had undergone completely nonfluoroscopic RF catheter ablation were evaluated. Ablation procedures were performed for atrial fibrillation, atrial flutter, atrioventricular reentry tachycardia, and pulmonary vein complex/ventricular tachycardia. Transseptal puncture and RF ablation were conducted under three-dimensional electroanatomic mapping and intracardiac echocardiography image guidance. Fluoroless transseptal puncture and catheter ablation were completed successfully in all cases, with no intraoperative complications. One patient required minimal use of fluoroscopy to visualize sheath advancement through an existing inferior vena cava filter. Procedural time was approximately 2.2 hours from transvenous access until case conclusion; transseptal access was obtained within 28 minutes of procedure initiation. Arrhythmia was found to recur in 27% of cases on average three months after the procedure. We demonstrate the safety and effectiveness of a completely fluoroless transseptal puncture and RF ablation technique that eliminates radiation exposure and enables complex electrophysiology procedures to be performed in a lead-free environment.
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Affiliation(s)
- Tariq Salam
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Lane Wilson
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Sara Bohannan
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
| | - Michael Morin
- Pulse Heart Institute, MultiCare Health System, Tacoma, WA, USA
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Eichenlaub M, Astheimer K, Minners J, Blum T, Restle C, Maring C, Schweitzer S, Thiel U, Neumann FJ, Arentz T, Lehrmann H. Evaluation of a new ultralow-dose radiation protocol for electrophysiological device implantation: A near-zero fluoroscopy approach for device implantation. Heart Rhythm 2019; 17:90-97. [PMID: 31494091 DOI: 10.1016/j.hrthm.2019.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiation is one of the main hazards of electrophysiological device implantation, and insertion of cardiac resynchronization therapy (CRT) devices in particular is associated with high radiation doses. OBJECTIVE The purpose of this study was to evaluate the impact of a new ultralow-dose radiation protocol on radiation doses, success rate, and safety of electrophysiological device implantations. METHODS In 2018, we established a new ultralow-dose radiation protocol (reduced pulse width, increased thickness of minimum copper filters, reduced detector entrance dose, reduced pulse rate, optimized image postprocessing settings) for de novo device implantation at our hospital. A total of 1173 patients (11% single-chamber devices, 69% dual-chamber devices, 20% CRT devices) were analyzed. Five hundred twelve patients (44%) in the ultralow-dose group were compared to 661 patients (66%) treated during 2017 with a conventional low-dose protocol. RESULTS With the ultralow-dose radiation protocol, effective doses could be reduced by 59% (median 0.25 [interquartile range: 0.11-0.63] vs median 0.10 [interquartile range: 0.03-0.28] mSv; P <.0001) per procedure without a significant change in procedure time (P = .5). This dose reduction could be achieved without decreasing procedure success (P = 1) or increasing complication rate (P = .8). Male gender, higher body mass index, increased procedure and fluoroscopy times, and use of the conventional radiation protocol were independent predictors of higher radiation doses in multivariate regression analysis. CONCLUSION By establishing a new ultralow-dose radiation protocol, we could significantly decrease radiation exposure, reaching the lowest radiation doses for electrophysiological device implantation reported to date.
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Affiliation(s)
- Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
| | - Klaus Astheimer
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Blum
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Christian Restle
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Christian Maring
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Saskia Schweitzer
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ulrike Thiel
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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11
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De Ponti R, My I, Vilotta M, Caravati F, Marazzato J, Bagliani G, Leonelli FM. Advanced Cardiac Signal Recording. Card Electrophysiol Clin 2019; 11:203-217. [PMID: 31084847 DOI: 10.1016/j.ccep.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Implantable loop recorders allow prolonged and continuous single-lead electrocardiogram recording, with the pivotal addition of remote monitoring. They have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias/tachyarrhythmias and proved helpful in arrhythmia burden definition, offering invaluable information in the diagnostic workup for syncope and atrial fibrillation. Advanced cardiac signal recording is also possible by transesophageal catheters. They have been used to orient diagnosis during wide and narrow QRS complex tachycardias and also to perform minimally invasive pacing. Intracardiac electrophysiologic study remains, however, essential for diagnosis of several arrhythmias in the perspective of curative catheter ablation.
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Affiliation(s)
- Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
| | - Ilaria My
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, 06034 Perugia, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
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12
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Extensive Use of 3D Nonfluoroscopic Mapping Systems for Reducing Radiation Exposure during Catheter Ablation Procedures: An Analysis of 10 Years of Activity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4217076. [PMID: 30984780 PMCID: PMC6431475 DOI: 10.1155/2019/4217076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2019] [Indexed: 01/16/2023]
Abstract
Purpose 3D nonfluoroscopic mapping systems (NMSs) are generally used in the catheter ablation (CA) of complex ventricular and atrial arrhythmias. The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of NMSs for CA. Methods Our study involved 1028 patients who underwent CA procedures from 2007 to 2016. Initially, CA procedures were performed mainly with the aid of fluoroscopy. From October 2008, NMSs were used for all procedures. Results The median fluoroscopy time of the overall CA procedures fell by 71%: from 29.2 min in 2007 to 8.4 min in 2016. Over the same period, total X-ray exposure decreased by 65%: from 58.18 Gy⁎cm2 to 20.19 Gy⁎cm2. This reduction was achieved without prolonging the total procedure time. In AF CA procedures, the median fluoroscopy time fell by 85%, with an 86% reduction in total X-ray exposure. In SVT CA procedures, the median fluoroscopy time fell by 93%, with a 92% reduction in total X-ray exposure. At the end of the follow-up period, the estimated probability of disease-free survival was 67.7% at 12 months for AF CA procedures and 97.2% at 3 months for SVT CA, without any statistically significant difference between years. Conclusions Our study shows the feasibility of using NMSs as the main imaging modality to guide CA. The extended, routine use of NMSs dramatically reduces radiation exposure, with only slight fluctuations due to the process of acquiring experience on the part of untrained operators, without affecting disease-free survival.
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13
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Sawhney V, Breitenstein A, Dhinoja M. Fluoroscopy times in electrophysiology and device procedures: impact of single frame location fluoroscopy. Eur Heart J 2019; 40:857. [PMID: 30428001 DOI: 10.1093/eurheartj/ehy744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vinit Sawhney
- Department of Cardiology, Barts Heart Centre, West Smithfields, London, UK
| | | | - Mehul Dhinoja
- Department of Cardiology, Barts Heart Centre, West Smithfields, London, UK
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14
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Holmqvist F, Kesek M, Englund A, Blomström-Lundqvist C, Karlsson LO, Kennebäck G, Poçi D, Samo-Ayou R, Sigurjónsdóttir R, Ringborn M, Herczku C, Carlson J, Fengsrud E, Tabrizi F, Höglund N, Lönnerholm S, Kongstad O, Jönsson A, Insulander P. A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes. Eur Heart J 2019; 40:820-830. [PMID: 30452631 PMCID: PMC6403459 DOI: 10.1093/eurheartj/ehy709] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/10/2018] [Accepted: 10/11/2018] [Indexed: 12/18/2022] Open
Abstract
AIMS Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported. METHODS AND RESULTS Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%). CONCLUSION Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.
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Affiliation(s)
- Fredrik Holmqvist
- Department of Cardiology, Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden
| | - Milos Kesek
- Department of Cardiology, Umeå University Hospital, SE-901 89, Umeå, Sweden
| | - Anders Englund
- Department of Clinical Sciences, South Hospital, Arrhythmia Center, Karolinska Institute, SE-118 61, Stockholm, Sweden
| | | | - Lars O Karlsson
- Department of Cardiology, Linköping University Hospital, SE-581 85, Linköping, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, SE-171 76, Solna, Sweden
| | - Dritan Poçi
- Department of Cardiology, University Hospital Örebro, SE-701 85, Örebro, Sweden
| | - Romeo Samo-Ayou
- Department of Cardiology, Skaraborg Hospital, SE-541 42, Skövde, Sweden
| | - Runa Sigurjónsdóttir
- Department of Cardiology, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden
| | - Michael Ringborn
- Thoracic Center, Blekinge County Hospital, S-371 85, Karlskrona, Sweden
| | - Csaba Herczku
- Department of Cardiology, Norra Älvsborg County Hospital, SE-461 73, Trollhättan, Sweden
| | - Jonas Carlson
- Department of Cardiology, Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden
| | - Espen Fengsrud
- Department of Cardiology, University Hospital Örebro, SE-701 85, Örebro, Sweden
| | - Fariborz Tabrizi
- Department of Clinical Sciences, South Hospital, Arrhythmia Center, Karolinska Institute, SE-118 61, Stockholm, Sweden
| | - Niklas Höglund
- Department of Cardiology, Umeå University Hospital, SE-901 89, Umeå, Sweden
| | - Stefan Lönnerholm
- Department of Cardiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Ole Kongstad
- Department of Cardiology, Skåne University Hospital, Lund University, SE-221 85 Lund, Sweden
| | - Anders Jönsson
- Department of Cardiology, Linköping University Hospital, SE-581 85, Linköping, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska University Hospital, SE-171 76, Solna, Sweden
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15
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Turagam MK, Vuddanda V, Atkins D, Venkata R, Yarlagadda B, Korra H, Pitchika J, Bommana S, Lakkireddy DR. Assessment of DNA Damage After Ionizing Radiation Exposure in Patients Undergoing Cardiac Resynchronization Therapy Device Implantation or Atrial Fibrillation Ablation (The RADAR Study). J Atr Fibrillation 2018; 11:2094. [PMID: 30505385 DOI: 10.4022/jafib.2094] [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: 06/22/2018] [Revised: 07/05/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022]
Abstract
Background There is limited data regarding effect of prolonged radiation exposure during electrophysiological (EP) procedures on direct DNA damage. Comet test has shown to assess DNA damage following radiation exposure. Methods We performed a single-center prospective observational study assessing direct DNA damage using the quantitative comet assay in patients undergoing cardiac resynchronization (CRT) and atrial fibrillation (AF) catheter ablation procedures. Venous comet assay was performed pre, immediately post procedure and at 3-month duration in twenty-two (N=22) patients who underwent catheter ablation for symptomatic AF and fourteen (N=14) patients who underwent CRT implantation. Results The median [interquartile range (IQR)] fluoroscopy time, radiation dose and dose area product (DAP) were 34.3 (27.97 - 45.48) minutes, 853.07 (611.36 - 1334.76) mGy and 16,994.10 (9,023.65 - 58,845.00) UGym2 in the ablation group and 30.05 (18.75 - 37.33) minutes, 345.00 (165.09 - 924.79) mGy and 11,837.20 [7182.67 - 35567.75] UGym2 in the CRT group. When compared with pre-procedure, there was a statistically significant increase in median (IQR) DNA migration on comet assay in the ablation group immediately post procedure [+6.55 µm (0.78, 10.25, p=0.02)] that subsequently decreased at 3 months [-1.00 µm (-2.20, 0.78), p=0.03] but not in the CRT group. Conclusion There was a significant increase in DNA damage as detected by comet assay immediately post procedure that normalized at 3 months in patients undergoing AF ablation. Further large prospective studies are warranted to evaluate the impact of this prolonged radiation exposure and DNA damage on long-term follow up.
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Affiliation(s)
| | - Venkat Vuddanda
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | | | - Rakesh Venkata
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Bhavya Yarlagadda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Himabindu Korra
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Jaya Pitchika
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
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16
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Patil KD, Marine JE. Fluoro-less ablation: Fleeting fad or way of the future? J Cardiovasc Electrophysiol 2018; 30:89-91. [PMID: 30311723 DOI: 10.1111/jce.13771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Kaustubha D Patil
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Wannagat S, Loehr L, Lask S, Völk K, Karaköse T, Özcelik C, Mügge A, Wutzler A. Implementation of a near-zero fluoroscopy approach in interventional electrophysiology: impact of operator experience. J Interv Card Electrophysiol 2018; 51:215-220. [PMID: 29460234 DOI: 10.1007/s10840-018-0333-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Catheter ablation is performed under fluoroscopic guidance. Reduction of radiation dose for patients and staff is emphasized by current recommendations. Previous studies have shown that lower operator experience leads to increased radiation dose. On the other hand, less experienced operators may depend even more on fluoroscopic guidance. Our study aimed to evaluate feasibility and efficacy of a non-fluoroscopic approach in different training levels. METHODS From January 2017, a near-zero fluoroscopy approach was established in two centers. Four operators (beginner, 1st year fellow, 2nd year fellow, expert) were instructed to perform the complete procedure with the use of a 3-D mapping system without fluoroscopy. A historical cohort that underwent procedures with fluoroscopy use served as control group. Dose area product (DPA), procedure duration, acute procedural success, and complications were compared between the groups and for each operator. RESULTS Procedures were performed in 157 patients. The first 100 patients underwent procedures with fluoroscopic guidance, the following 57 procedures were performed with the near-zero fluoroscopy approach. The results show a significant reduction in DPA for all operators immediately after implementation of the near-zero fluoroscopy protocol (control 637 ± 611 μGy/m2; beginner 44.1 ± 79.5 μGy/m2, p = 0.002; 1st year fellow 24.3 ± 46.4.5 μGy/m2, p = 0.001; 2nd year fellow 130.3 ± 233.3 μGy/m2, p = 0.003; expert 9.3 ± 37.4 μGy/m2, P < 0.001). Procedure duration, acute success, and complications were not significantly different between the groups. CONCLUSION Our results show a 90% reduction of DPA shortly after implementation of a near-zero fluoroscopy approach in interventional electrophysiology even in operators in training.
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Affiliation(s)
- Severin Wannagat
- Cardiovascular Centre, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Lena Loehr
- Cardiovascular Centre, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Sebastian Lask
- Cardiovascular Centre, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Katharina Völk
- Cardiovascular Centre, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Tamer Karaköse
- Department of Cardiology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Cemil Özcelik
- Department of Cardiology, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Andreas Mügge
- Cardiovascular Centre, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Alexander Wutzler
- Cardiovascular Centre, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
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18
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Attanasio P, Mirdamadi M, Wielandts JY, Pieske B, Blaschke F, Boldt LH, Jais P, Haverkamp W, Huemer M. Safety and efficacy of applying a low-dose radiation fluoroscopy protocol in device implantations. Europace 2017; 19:1364-1368. [PMID: 27702866 DOI: 10.1093/europace/euw189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/28/2016] [Indexed: 11/14/2022] Open
Abstract
Aims For cardiac implantable electronic device (CIED) implantations, visualization of lead placement is necessary and fluoroscopy remains by far the most commonly used technique. With simple changes in the X-ray system settings, total radiation dose can be reduced significantly. The purpose of this study was to assess the safety and efficacy of various CIED implantations performed after implementation of a new dose reduction protocol (DRP). Methods and results We conducted a retrospective chart review of 584 patients undergoing CIED implantation or revision in our hospital. Of these patients, 280 (48%) underwent the implantation prior to and 304 (52%) after the DRP introduction. The DRP included various changes for optimized image processing and exposure system settings to enable dose reduction, as well as a reduced frame rates (4 FPS for fluoroscopy and 7.5 FPS for cinematographic images). Of the 584 patients, 53 (9.1%) had a one-chamber pacemaker, 232 (39.7%) a two-chamber pacemaker, 133 (22.8%) a one-chamber ICD, 35 (6.0%) a two-chamber ICD, 82 (14.0%) a CRT (de novo) implantation, and 49 (8.3%) had an upgrade to a CRT device. DRP was associated with a 64% reduction of the dose-area product (1372 ± 2659 vs. 3792 ± 5025 cGcm2, P < 0.001), while fluoroscopy duration (13 ± 15 vs. 13 ± 15 min) and procedural duration (93 ± 52 vs. 92 ± 52 min.) did not significantly increase. Complication rates did not differ significantly between the two groups. Conclusion The DRP proved to effectively reduce radiation dose for all types of CIED implantations. Fluoroscopy time, total procedure time, and the number of complications did not increase after introducing the DRP.
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Affiliation(s)
- Philipp Attanasio
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
| | - Melika Mirdamadi
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
| | - Jean-Yves Wielandts
- Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France.,L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany.,Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
| | - Leif-Hendrik Boldt
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
| | - Pierre Jais
- Department of cardiac pacing and electrophysiology, CHU/Université de Bordeaux, Pessac, France.,L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC, CHU/Université de Bordeaux/INSERM U1045, Pessac, France
| | - Wilhelm Haverkamp
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
| | - Martin Huemer
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
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Lim PCY, Toh JJH, Loh JKXY, Lee ECY, Chong DTT, Tan BY, Ho KL, Ching CK, Teo WS. Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction. J Arrhythm 2017; 33:167-171. [PMID: 28607610 PMCID: PMC5459423 DOI: 10.1016/j.joa.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023] Open
Abstract
Background Percutaneous transcatheter radiofrequency ablation of atrial fibrillation with remote controlled magnetic navigation (RMN) has been shown to reduce radiation exposure to patients and physicians compared with conventional manual (MAN) ablation techniques. Methods Catheter ablation for atrial fibrillation was performed utilizing RMN in 214 consecutive patients and MAN ablation techniques in 229 patients. We compared the fluoroscopy and procedural times between RMN and MAN catheter ablation of atrial fibrillation. Secondary objectives included comparing acute procedural success and short-term complication rates between both ablation strategies. Results Fluoroscopy time was significantly shorter in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6 min, respectively; p<0.01); however, the total procedural time was longer in the RMN group (280.2±74.4 min vs 213.1±64.75, respectively; p>0.001). Further subgroup analysis of the most recent 50 ablations each from the RMN and MAN groups, to attenuate the RMN learning curve effect, showed an even greater difference in fluoroscopy time (RMN vs MAN: 53.5±30.1 vs 68.1±27.6 min), though a consistently longer procedure time with RMN (249.5±65.5 vs 186.3±65.6 min, respectively). The acute procedural success rate was comparable between the groups (98.6% vs 95.6%, respectively; p=0.07). The rates of acute complications were similar in both groups (2.3% vs 4.8%, respectively; p=0.16). Conclusions In radiofrequency ablation of atrial fibrillation, RMN appears to significantly reduce fluoroscopy time compared with conventional MAN ablation, though at a cost of increased total procedural time, with comparable acute success rates and safety profile. A reduction in procedure and fluoroscopy times is possible with gaining experience.
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20
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Behar JM, Claridge S, Jackson T, Sieniewicz B, Porter B, Webb J, Rajani R, Kapetanakis S, Carr-White G, Rinaldi CA. The role of multi modality imaging in selecting patients and guiding lead placement for the delivery of cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2016; 15:93-107. [DOI: 10.1080/14779072.2016.1252674] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan M Behar
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Simon Claridge
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Tom Jackson
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ben Sieniewicz
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Bradley Porter
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Jessica Webb
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | - Ronak Rajani
- Department of Cardiology, St. Thomas’ Hospital, London, UK
| | | | | | - Christopher A Rinaldi
- Department of Imaging Sciences & Biomedical Engineering, King’s College London, London, UK
- Department of Cardiology, St. Thomas’ Hospital, London, UK
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21
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Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases. Eur Radiol 2016; 27:1954-1962. [PMID: 27553931 DOI: 10.1007/s00330-016-4560-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. METHODS After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. RESULTS Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. CONCLUSIONS Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. KEY POINTS • Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine. • Active catheter-tracking allows efficient catheter navigation also in a transseptal approach. • More MR-conditional tools are needed to facilitate left atrial interventions in humans.
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22
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Gaita F, Guerra PG, Battaglia A, Anselmino M. The dream of near-zero X-rays ablation comes true. Eur Heart J 2016; 37:2749-2755. [DOI: 10.1093/eurheartj/ehw223] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/12/2016] [Indexed: 11/15/2022] Open
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23
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Ernst S. Multielectrode Pulmonary Vein Isolation Versus Single Tip Wide Area Catheter Ablation-Paroxysmal Atrial Fibrillation: Is There Any Mystery in Pulmonary Vein Isolation? Circ Arrhythm Electrophysiol 2016; 9:e004077. [PMID: 27071828 DOI: 10.1161/circep.116.004077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sabine Ernst
- From the Department of Cardiology, Royal Brompton and Harefield Hospital, and Imperial College London, London, United Kingdom.
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