Radiofrequency catheter ablation of left-sided accessory pathways in children using a new fluoroscopy integrated 3D-mapping system

Introduction Detail 3D mapping have been useful for effective radiofrequency catheter ablation. Rhythmia system can create the atrio-ventricular dual chamber mapping, which reveals the atrial and ventricular potentials all at once in the same map. The aim of this study was to investigate the utility of Rhythmia system for catheter ablation of accessory pathways (AP). Methods From July 2015 to August 2020, 111 patients underwent ablation of APs. The dual chamber mappings were created in 50 patients [median age 15 (10-54), 32 male(64.0%)], while 61 patients underwent the radiofrequency (RF) ablations with conventional single chamber 3D mappings. The background characteristics and procedure details were compared between the dual chamber mapping group and conventional single chamber mapping group. Results The number of RF application [1 (1-3) vs 3 (1-6), p=0.0023], RF time [9.2 (2.0-95.7) vs 95.6 (4.1-248.7), p=0.0023], RF energy [248.4 (58.7-3328.2) vs 2867.6 (134.2-7728.4), p=0.0115] were significantly lower in dual chamber group. Fluoroscopy time [19.9 (14.2-26.1) vs 26.5 (17.7-43.4), p=0.0025], and fluoroscopy dose [52.5 (31.3-146.0) vs 119.0 (43.7-213.5), p=0.0249] were also significantly lower than in single chamber mapping group. Conclusion The dual chamber mappings were useful for effective ablation with reducing the radiation exposure.

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14.6 Catheter ablation of unmappeable ventricular tachycardiasin patients with implantable cardiac defibrillators using a 3D mapping system

EP Europace ◽

10.1016/eupace/4.supplement_1.a24-c ◽

2003 ◽

Vol 4 (Supplement_1) ◽

pp. A24-A24

Author(s):

J. Atie

Keyword(s):

Catheter Ablation ◽

3D Mapping ◽

Mapping System ◽

3D Mapping System ◽

Implantable Cardiac Defibrillators

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Fluoroless and contrast-free catheter ablation without a lead apron in routine clinical practice

Scientific Reports ◽

10.1038/s41598-020-74165-y ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Takumi J. Matsubara ◽

Katsuhito Fujiu ◽

Yu Shimizu ◽

Tsukasa Oshima ◽

Jun Matsuda ◽

...

Keyword(s):

Clinical Practice ◽

Catheter Ablation ◽

Radiation Exposure ◽

Routine Clinical Practice ◽

Paroxysmal Supraventricular Tachycardia ◽

Complication Rates ◽

3D Mapping ◽

Procedure Time ◽

Mapping System ◽

3D Mapping System

Abstract The technique of catheter ablation has been improved within the past few decades, especially by three-dimensional (3D) mapping system. 3D mapping system has reduced radiation exposure but ablation procedures still require fluoroscopy. Our previous study showed the safety and efficacy of catheter ablation based on intracardiac echogram combined with CARTOSOUND/CARTO3 system, however fluoroscopy use for an average of 16 min is required for this procedure. The present study was aimed to reduce radiation exposure to zero and establish a radiation free catheter ablation method with the goal of utilizing it in routine clinical practice. We conducted single center, retrospective study during 2019 April to 2020 February. Consecutive 76 patients were enrolled. In the first 18 cases, the previously reported procedure (CARTOSOUND/CARTO3 method) was used. The remaining 58 cases were transitioned to fluoroless catheter ablation. The procedure time, success rates and complication rates were analyzed. Not only AF patients but atrial flutter (AFL), paroxysmal supraventricular tachycardia (PSVT) and ventricular arrhythmia patients were included. Catheter positioning, catheter visualization and collecting the geometry of each camber of the heart were conducted by using contact force and ICE based geometry on CARTO system without either prior computed tomography (CT) or magnetic resonance image (MRI). In fluoroless group, all catheter ablations were successfully performed without lead aprons. No complications occurred in either group. There were no significant differences in procedure time in any type of procedure (Total procedure time Fluoro-group; 149 ± 51 min vs. Fluoroless-group; 162 ± 43 min, N.S.), (PSVT 170 ± 53 min vs. 162 ± 29 min, N.S.), (AFL 110 ± 70 min vs. 123 ± 43 min, N.S.), (AF 162 ± 43 min vs. 163 ± 32 min, N.S.). The total radiation time was reduced to zero in fluoroless group. Catheter ablation with ICE and 3D mapping system guide without fluoroscopy could be safely performed with a high success rate, without any prior CT/MRI 3D images. Radiation was reduced completely for patients and staff, negating the need for protective wear for operators.

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