scholarly journals Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

2021 ◽  
Vol 23 (4) ◽  
Author(s):  
Christopher S. Purtell ◽  
Ryan T. Kipp ◽  
Lee L. Eckhardt
Keyword(s):  
Cardiac Electrophysiology ◽  
Imaging Technique ◽  
Early Experience ◽  
Intracardiac Echocardiography ◽  
Electroanatomic Mapping ◽  
Supporting Evidence ◽  
Device Implantation ◽  
Mri Guidance ◽  
Fluoroscopic Imaging ◽  
Mapping Systems

Abstract Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.

Utility of Intracardiac Echocardiography in the Early Experience of Transcatheter Edge to Edge Tricuspid Valve Repair

2021 ◽  
Author(s):  
Mackram F. Eleid ◽  
Mohamad Alkhouli ◽  
Jeremy J. Thaden ◽  
Firas Zahr ◽  
Scott Chadderdon ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Imaging Modality ◽  
Early Experience ◽  
Intracardiac Echocardiography ◽  
Tricuspid Valve Repair ◽  
Severe Tricuspid Regurgitation ◽  
Mitral Repair ◽  
Novel Treatment ◽  
Over Time

Background: Tricuspid edge to edge repair (TEER) is a novel treatment for severe tricuspid regurgitation and is highly dependent on intraprocedural image quality. To date, transesophageal echocardiography (TEE) has been the primary imaging modality used to guide TEER. The role of intracardiac echocardiography (ICE) has not been assessed. The objective of this study was to describe the use and role of 2-dimensional ICE in the early experience of TEER. Methods: Consecutive patients undergoing TEER (with or without concomitant mitral repair) with off-label use of MitraClip (Abbott, Santa Clara, CA) were included in the study. Utilization of 2-dimensional ICE in comparison with TEE imaging were collected in each procedure through retrospective review of the procedural reports and images. Results: Of 42 TEER cases, ICE was used in 15 (36%) and concomitant mitral repair was performed in 37 (86%). ICE was increasingly used over time for TEER. ICE was able to visualize the tricuspid leaflets with high resolution and provided superior leaflet visualization to TEE in 40% of cases where it was used. Patients treated with ICE guidance tended to have a greater baseline severity of tricuspid regurgitation compared with patients treated with TEE guidance alone (8/15 [53%] massive or greater tricuspid regurgitation versus 6/27 [22%]; P =0.09). Degree of tricuspid regurgitation reduction was similar with TEE alone versus ICE plus TEE guidance (1.9±1.0 versus 2.1±1.1 grade reduction, P =0.28). Conclusions: ICE was increasingly used in the early experience of TEER over time. ICE facilitates leaflet visualization for grasping and is a useful adjunct to TEE during TEER.

scholarly journals Contemporary Mapping Techniques of Complex Cardiac Arrhythmias — Identifying and Modifying the Arrhythmogenic Substrate

2015 ◽  
Vol 4 (1) ◽  
pp. 19 ◽  
Author(s):  
Emmanuel Koutalas ◽  
Sascha Rolf ◽  
Borislav Dinov ◽  
Sergio Richter ◽  
Arash Arya ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Cardiac Electrophysiology ◽  
Ventricular Tachycardia Ablation ◽  
Substrate Modification ◽  
Improved Outcomes ◽  
Arrhythmogenic Substrate ◽  
Reasonable Cost ◽  
Conventional Mapping ◽  
Mapping Techniques ◽  
Mapping Systems

Cardiac electrophysiology has moved a long way forward during recent decades in the comprehension and treatment of complex cardiac arrhythmias. Contemporary electroanatomical mapping systems, along with state-of-the-art technology in the manufacture of electrophysiology catheters and cardiac imaging modalities, have significantly enriched our armamentarium, enabling the implementation of various mapping strategies and techniques in electrophysiology procedures. Beyond conventional mapping strategies, ablation of complex fractionated electrograms and rotor ablation in atrial fibrillation ablation procedures, the identification and modification of the underlying arrhythmogenic substrate has emerged as a strategy that leads to improved outcomes. Arrhythmogenic substrate modification also has a major role in ventricular tachycardia ablation procedures. Optimisation of contact between tissue and catheter and image integration are a further step forward to augment our precision and effectiveness. Hybridisation of existing technologies with a reasonable cost should be our goal over the next few years.

How to perform electroanatomic mapping-guided cardiac resynchronization therapy using Carto 3 and ESI NavX three-dimensional mapping systems

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1742-1749 ◽  
Author(s):  
Henry D Huang ◽  
Parikshit S Sharma ◽  
Hemal M Nayak ◽  
Nicholas Serafini ◽  
Richard G Trohman
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Three Dimensional ◽  
Electroanatomic Mapping ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Jude Medical ◽  
Lead Placement ◽  
Significant Difference ◽  
Qrs Duration ◽  
Mapping Systems

Abstract Aims  To examine the feasibility and safety of a novel protocol for low fluoroscopy, electroanatomic mapping (EAM)-guided Cardiac resynchronization therapy with a defibrillator (CRT-D) implantation and using both EnSite NavX (St. Jude Medical, St. Paul, MN, USA) and Carto 3 (Biosense Webster, Irvine, CA, USA) mapping systems. Methods and results Twenty consecutive patients underwent CRT implantation using either a conventional fluoroscopic approach (CFA) or EAM-guided lead placement with Carto 3 and EnSite NavX mapping systems. We compared fluoroscopy and procedural times, radiopaque contrast dose, change in QRS duration pre- and post-procedure, and complications in all patients. Fluoroscopy time was 86% lower in the EAM group compared to the conventional group [mean 37.2 min (CFA) vs. 5.5 min (EAM), P = 0.00003]. There was no significant difference in total procedural time [mean 183 min (CFA) vs. 161 min (EAM), P = 0.33] but radiopaque contrast usage was lower in the EAM group [mean 16 mL (CFA) vs. 4 mL (EAM), P = 0.006]. Likewise, there was no significant change in QRS duration with BiV pacing between the groups [mean −13 (CFA) vs. −25 ms (EAM), P = 0.09]. Conclusion  Electroanatomic mapping-guided lead placement using either Carto or ESI NavX mapping systems is a feasible alternative to conventional fluoroscopic methods for CRT-D implantation utilizing the protocol described in this study.

scholarly journals 35 Electrophysiology and electrostimulation: experience

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Stefano Santucci ◽  
Davide Negossi ◽  
David Emanuelli ◽  
Valentina Paoloni ◽  
Federico Biondi ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Dose Reduction ◽  
Cardiac Electrophysiology ◽  
Patient Management ◽  
Technological Development ◽  
Rhythm Control ◽  
Electroanatomical Mapping ◽  
Continuous Training ◽  
Intensive Use ◽  
Mapping Systems

Abstract In the last 50 years, cardiac electrophysiology has undergone rapid technological development which has led to a numerical increase in both patients who have been able to benefit from the therapies of rediscovery and rhythm control, and of the devices. The activity of an electrophysiology and electrostimulation room is based on the intensive use of ionizing radiation even if electrophysiology studies, ablation, and cryoablation techniques have benefited from the support of computerized electroanatomical mapping systems with consequent dose reduction. Over the years, the instruments to be managed inside the room have increased both in complexity and numerically. Starting from the biventricular PM, we go through the implantation of subcutaneous defibrillators up to the transseptal ablations. Patient management requires additional skills that each member of the team must possess. Continuous training and updates are of fundamental importance. The purpose of this work is our experience based on the activity now more 10 years.

scholarly journals Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology

2017 ◽  
Vol 6 (2) ◽  
pp. 85 ◽  
Author(s):  
Henry Chubb ◽  
Steven E Williams ◽  
John Whitaker ◽  
James L Harrison ◽  
Reza Razavi ◽  
...  
Keyword(s):  
Cardiac Electrophysiology ◽  
Ablation Lesion ◽  
Clinical Implementation ◽  
Lesion Formation ◽  
Mri Guidance ◽  
Mr Guidance ◽  
Recent Developments ◽  
Procedural Guidance ◽  
Time Assessment ◽  
Device Tracking

MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.

scholarly journals Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology

2017 ◽  
Vol 6 (2) ◽  
pp. 85 ◽  
Author(s):  
Henry Chubb ◽  
Steven E Williams ◽  
John Whitaker ◽  
James L Harrison ◽  
Reza Razavi ◽  
...  
Keyword(s):  
Cardiac Electrophysiology ◽  
Ablation Lesion ◽  
Clinical Implementation ◽  
Lesion Formation ◽  
Mri Guidance ◽  
Mr Guidance ◽  
Recent Developments ◽  
Procedural Guidance ◽  
Time Assessment ◽  
Device Tracking

MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.

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