Fluoroless Catheter Ablation of Cardiac Arrhythmias

Catheter ablation is the mainstay of cardiac arrhythmia management, and the number of these procedures carried out is continuing to grow. Fluoroscopy has been integral to these procedures to ensure safe catheter manipulation. Unfortunately, exposure to ionizing radiation is associated with several health risks to patients and personnel. The personal protective equipment used to reduce these risks is associated with incomplete protection and orthopedic risks to physicians and other staff. 3D mapping systems and intracardiac echocardiography, if used properly, can significantly reduce the use of fluoroscopy. The study describes a zero-fluoroscopy approach to cardiac ablation of AF and other arrhythmias using 3D mapping and intracardiac echocardiography to reduce or eliminate exposure to ionizing radiation and orthopedic risks to personnel.

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Electroanatomic Mapping for Catheter Ablation of Cardiac Arrhythmias

Mayo Clinic Electrophysiology Manual ◽

10.1093/med/9780199941193.003.0003 ◽

2013 ◽

pp. 75-84 ◽

Cited By ~ 1

Author(s):

Amit Noheria ◽

Traci L. Buescher ◽

Samuel J. Asirvatham

Keyword(s):

Catheter Ablation ◽

Cardiac Arrhythmias ◽

Electroanatomic Mapping ◽

3 Dimensional ◽

Case Discussions ◽

Dimensional Mapping ◽

Mapping Systems ◽

Arrhythmia Management

Examples of the use of 3 dimensional mapping systems are found throughout the detailed discussion of instructive arrhythmia cases in this text. Although the systems provide a powerful tool to better treat complex arrhythmia, the student of electrophysiology should be aware of the various pitfalls that sometimes result in confusion and inaccuracy with interpretation. The examples in this chapter give a basic appreciation of how the technology is used in arrhythmia management. The case discussions that follow include the specific utilities and pitfalls to avoid during application of these technologies.

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Catheter ablation of short-coupled variant of torsade de pointes

Clinical Research in Cardiology ◽

10.1007/s00392-021-01840-z ◽

2021 ◽

Author(s):

Johannes Steinfurt ◽

Babak Nazer ◽

Martin Aguilar ◽

Joshua Moss ◽

Satoshi Higuchi ◽

...

Keyword(s):

Catheter Ablation ◽

Torsade De Pointes ◽

Intracardiac Echocardiography ◽

Long Term Results ◽

Electrical Storm ◽

3D Mapping ◽

Free Wall ◽

First Line ◽

First Line Therapy ◽

Line Therapy

Abstract Background The short-coupled variant of torsade de pointes (sc-TdP) is a malignant arrhythmia that frequently presents with ventricular fibrillation (VF) electrical storm. Verapamil is considered the first-line therapy of sc-TdP while catheter ablation is not widely adopted. The aim of this study was to determine the origin of sc-TdP and to assess the outcome of catheter ablation using 3D-mapping. Methods and results We retrospectively analyzed five patients with sc-TdP who underwent 3D-mapping and ablation of sc-TdP at five different institutions. Four patients initially presented with sudden cardiac arrest, one patient experienced recurrent syncope as the first manifestation. All patients demonstrated a monomorphic premature ventricular contraction (PVC) with late transition left bundle branch block pattern, superior axis, and a coupling interval of less than 300 ms. triggering recurrent TdP and VF. In four patients, the culprit PVC was mapped to the free wall insertion of the moderator band (MB) with a preceding Purkinje potential in two patients. Catheter ablation using 3D-mapping and intracardiac echocardiography eliminated sc-TdP in all patients, with no recurrence at mean 2.7 years (range 6 months to 8 years) of follow-up. Conclusion 3D-mapping and intracardiac echocardiography demonstrate that sc-TdP predominantly originates from the MB free wall insertion and its Purkinje network. Catheter ablation of the culprit PVC at the MB free wall junction leads to excellent short- and long-term results and should be considered as first-line therapy in recurrent sc-TdP or electrical storm. Graphic abstract

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A Zero-Fluoroscopy Approach to Cavotricuspid Isthmus Catheter Ablation: Comparative Analysis of Two Electroanatomical Mapping Systems

Pacing and Clinical Electrophysiology ◽

10.1111/pace.12376 ◽

2014 ◽

Vol 37 (8) ◽

pp. 1029-1037 ◽

Cited By ~ 21

Author(s):

ROSA MACÍAS ◽

INÉS URIBE ◽

LUIS TERCEDOR ◽

JUAN JIMÉNEZ-JÁIMEZ ◽

TERESA BARRIO ◽

...

Keyword(s):

Comparative Analysis ◽

Catheter Ablation ◽

Electroanatomical Mapping ◽

Cavotricuspid Isthmus ◽

Mapping Systems ◽

Zero Fluoroscopy

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Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

Cardiology Research and Practice ◽

10.1155/2021/5561574 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Fei Hang ◽

Liting Cheng ◽

Zhuo Liang ◽

Ruiqing Dong ◽

Xinlu Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Radiofrequency Catheter Ablation ◽

Intracardiac Echocardiography ◽

Transseptal Puncture ◽

Electroanatomical Mapping ◽

Curative Effect ◽

Significant Difference ◽

Zero Fluoroscopy

Aims. 3D electroanatomical mapping combined with intracardiac echocardiography- (EAM-ICE-) guided transseptal puncture has been proven safe and effective during the radiofrequency catheter ablation (RFCA) procedure used to treat paroxysmal atrial fibrillation (PAF). In this study, we aimed to compare the curative effect and safety of RFCA via F (fluoroscopy) and zero-fluoroscopy transseptal puncture guided by EAM-ICE in patients with PAF. Methods and Results. A prospective study in which 110 patients with PAF were included and assigned to two groups was conducted. Fifty-five (50%) patients were enrolled in the EAM-ICE group, whereas the other 55 (50%) patients were enrolled in the F group. There were no significant differences in baseline characteristics between the two groups. The transseptal duration time was longer in the EAM-ICE group (19.8 ± 3.0 min vs. 8.6 ± 1.2 min, p ≤ 0.01 ); however, fluoroscopy was not used in the EAM-ICE group compared with the F group (0 mGy vs. 109.1 ± 57.9 mGy). Similarly, there was also no significant difference in the recurrence rate of atrial fibrillation between the EAM-ICE and F groups (25.5% vs. 18.2%, p = 0.356 ). Conclusion. RFCA via EAM-ICE-guided zero-fluoroscopy transseptal puncture in patients with PAF is safe and effective for long-term follow-up.

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Utility of Intracardiac Echocardiography for Catheter Ablation of Complex Cardiac Arrhythmias in a Medium-Volume Training Center

Echocardiography ◽

10.1111/echo.12714 ◽

2014 ◽

Vol 32 (4) ◽

pp. 660-670 ◽

Cited By ~ 13

Author(s):

David Filgueiras-Rama ◽

Fernando de Torres-Alba ◽

Sergio Castrejón-Castrejón ◽

Alejandro Estrada ◽

Jorge Figueroa ◽

...

Keyword(s):

Catheter Ablation ◽

Cardiac Arrhythmias ◽

Intracardiac Echocardiography ◽

Training Center

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Transjugular approach for zero-fluoroscopy catheter ablation of the right anterolateral accessory pathway

Slovenian Medical Journal ◽

10.6016/zdravvestn.2926 ◽

2019 ◽

Vol 88 (9-10) ◽

pp. 464-67

Author(s):

Tine Prolič Kalinšek ◽

David Žižek ◽

Matevž Jan

Keyword(s):

Catheter Ablation ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Accessory Pathway ◽

Three Dimensional ◽

Vena Cava ◽

Intracardiac Echocardiography ◽

Congenital Agenesis ◽

The Right ◽

Zero Fluoroscopy

We present a case of successful zero-fluoroscopy catheter ablation (CA) of the right anterolateral accessory (AP) pathway via a transjugular approach in an 18-year-old patient with a congenital agenesis of inferior vena cava (IVC). Three-dimensional (3D) electroanatomic mapping (EAM) system and intracardiac echocardiography (ICE) were used to navigate the catheters in the heart.

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Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

10.22541/au.163275342.22402544/v1 ◽

2021 ◽

Author(s):

yi he chen ◽

Liangguo Wang ◽

Xiaodong Zhou ◽

ying fang ◽

Lan Su ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Intracardiac Echocardiography ◽

Atrial Appendage ◽

Adverse Event Rate ◽

Left Atrial Appendage Closure ◽

Zero Fluoroscopy

Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. Methods and Results:From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2DS2-VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

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Automatic detection and mapping of double potentials in intracardiac electrograms

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2016-0041 ◽

2016 ◽

Vol 2 (1) ◽

pp. 179-183 ◽

Cited By ~ 1

Author(s):

Tobias Oesterlein ◽

Alexander Kramlich ◽

Gustavo Lenis ◽

Armin Luik ◽

Claus Schmitt ◽

...

Keyword(s):

Signal Processing ◽

Catheter Ablation ◽

Decision Tree ◽

Cardiac Arrhythmias ◽

State Of The Art ◽

Morphological Descriptors ◽

Binary Decision ◽

Binary Decision Tree ◽

Cardiac Excitation ◽

Mapping Systems

AbstractCatheter ablation has become a very efficient strategy to terminate sustained cardiac arrhythmias like atrial flutter (AFlut). Identification of the optimal ablation spot, however, often proves difficult when scar from previous ablations is present. Although the application of electro-anatomical mapping systems allows to record thousands of intracardiac electrograms (EGMs) from each atrium, state-of-the-art techniques provide limited options for automatic signal processing. Goal of the presented research was the development of an algorithm to detect EGMs that present double potentials (DPs), as these often indicate functional or anatomical lines of block for cardiac excitation. Using an annotated database, we developed several features based on the morphological descriptors of DPs. These were used to train a binary decision tree which was able to detect DPs with a correct rate of over 90%.

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P377Zero-fluoroscopy ablation with ultrasound-guided sheath insertion

EP Europace ◽

10.1093/europace/euaa162.195 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T Kawakami ◽

N Saitoh ◽

Y Asukai ◽

S Wada ◽

H Sasaki ◽

...

Keyword(s):

Catheter Ablation ◽

Contact Force ◽

Femoral Vein ◽

Posterior Wall ◽

Intracardiac Echocardiography ◽

Ultrasound Guided ◽

Fluoroscopic Time ◽

Force Monitoring ◽

Sheath Insertion ◽

Zero Fluoroscopy

Abstract Background Radiation exposure during catheter ablation procedures is a risk for both the patient and electrophysiology staff. Recently, the feasibility and effectiveness of zero-fluoroscopy ablation have been shown. However, ensuring a safe sheath insertion through the venous system toward the heart is a concern in catheter ablation using the zero-fluoroscopy technique. Purpose The objective of this study was to confirm feasibility and safety for zero-fluoroscopy ablation using ultrasound-guided sheath insertion. Methods Zero-fluoroscopy catheter ablation was performed in 220 patients (185 patients with atrial fibrillation (AF), 26 patients with supraventricular tachycardia (SVT), and nine patients with ventricular arrhythmias (VA)) using a 3-dimensional electro-anatomical mapping system, contact force monitoring, and intracardiac echocardiography (ICE) imaging. In all cases, ultrasound-guided sheath insertion was performed through the femoral vein. In 6 cases of VA, the retrograde approach through the femoral artery was performed with ICE imaging and contact-force monitoring. The endpoint of ablation for AF was pulmonary vein ablation in all cases and addition of left atrial posterior wall isolation in persistent AF cases. The endpoint of ablation for SVT and VA was noninducibility after ablation. Results The endpoints of ablation were achieved in all cases. The fluoroscopic time during ablation procedures was 0 seconds. There were two complications (one cardiac tamponade and one acute heart failure). There were no complications related to sheath insertion. Conclusions Zero-fluoroscopy catheter ablation with ultrasound-guided sheath insertion may be feasible and can be performed safely. This method eliminates exposure radiation safely, which is a concern of zero-fluoroscopy endocardial catheter ablation.

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