Combined use of electro-anatomic mapping system and intracardiac echocardiography to achieve zero-fluoroscopy catheter ablation for treatment of paroxysmal atrial fibrillation: a single centre experience
Fluoroscopy is the principal imaging method for catheter ablation (CA) of atrial fibrillation (AF). However, radiation exposure carries potential health risk to patients and operators alike. Our aim was to study safety and efficacy of zero-fluoroscopy CA of paroxysmal AF with a combined use of electroanatomic mapping system (EAM) and intracardiac echocardiography (ICE). In addition, impact of ICE/EAM automatic integration system and contact force (CF) sensing technology on procedural times were assessed. We included 144 consecutive patients (69% males, age 60 ± 10 years, BMI 29 ± 4,6) referred for CA of symptomatic paroxysmal AF. All procedures were performed only with EAM system and ICE. No fluoroscopy was used. The acute procedural success of complete pulmonary vein isolation was achieved in all patients (100%) and adverse events were detected in eight patients (5.6%). In 53 (37%) patients the use of ICE/EAM automatic integration system shortened procedural times compared to those performed without it (148 ± 35 vs. 187 ± 44 min, p < 0.05). Similarly, 89 (60%) procedures where CF sensing catheter was used were shorter compared to those performed without it (163 ± 41 vs. 188 ± 46 min, p < 0.05). Zero-fluoroscopy approach for treatment of paroxysmal AF seems feasible, safe, and acutely effective. Additional reduction of procedural times could be achieved with the use of ICE/EAM automatic integration system and CF sensing technology.
KeywordsZero-fluoroscopy Catheter ablation Paroxysmal atrial fibrillation Electro-anatomic mapping system Intracardiac echocardiography
Compliance with ethical standards
Conflict of interest
Matevž Jan and Bor Antolič have received honoraria from Biosense Webster. These honoraria were unrelated to the present study.
The study complies with the Declaration of Helsinki. The study protocol was approved by The National Medical Ethics Committee.
All patients gave written informed consent before entering the study.
- 13.Kühne M, Knecht S, Mühl A, Reichlin T, Pavlović N, Kessel-Schaefer A, Kaufmann BA, Schaer B, Sticherling C, Osswald S (2016) Fluoroscopy-free pulmonary vein isolation in patients with atrial fibrillation and a patent foramen ovale using solely an electroanatomic mapping system. PLoS ONE 11(1):e0148059CrossRefGoogle Scholar
- 16.Razminia M, Manankil MF, Eryazici PL, Arrieta-Garcia C, Wang T, D’Silva OJ, Lopez CS, Crystal GJ, Khan S, Stancu MM, Turner M, Anthony J, Zheutlin TA, Kehoe RF (2012) Nonfluoroscopic catheter ablation of cardiac arrhythmias in adults: feasibility, safety, and efficacy. J Cardiovasc Electrophysiol 23(10):1078–1086CrossRefGoogle Scholar
- 17.Baran J, Zaborska B, Piotrowski R, Sikora-Frąc M, Pilichowska-Paszkiet E, Kułakowski P (2017) Intracardiac echocardiography for verification for left atrial appendage thrombus presence detected by transesophageal echocardiography: the ActionICE II study. Clin Cardiol 40(7):450–454CrossRefGoogle Scholar
- 19.Filgueiras-Rama D, de Torres-Alba F, Castrejón-Castrejón S, Estrada A, Figueroa J, Salvador-Montañés Ó, López T, Moreno-Yanguela M, López Sendón JL, Merino JL (2015) Utility of intracardiac echocardiography for catheter ablation of complex cardiac arrhythmias in a medium-volume training center. Echocardiography. 32(4):660–670CrossRefGoogle Scholar
- 24.Stec S, Śledź J, Mazij M, Raś M, Ludwik B, Chrabąszcz M, Śledź A, Banasik M, Bzymek M, Młynarczyk K, Deutsch K, Labus M, Śpikowski J, Szydłowski L (2014) Feasibility of implementation of a “simplified, no-X-ray, no-lead apron, two-catheter approach” for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol 25(8):866–874CrossRefGoogle Scholar
- 26.Phlips T, Taghji P, El Haddad M, Wolf M, Knecht S, Vandekerckhove Y, Tavernier R, Duytschaever M (2018) Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. Europace 20(FI_3):f419–f427CrossRefGoogle Scholar
- 28.Mörtsell D, Arbelo E, Dagres N, Brugada J, Laroche C, Trines SA, Malmborg H, Höglund N, Tavazzi L, Pokushalov E, Stabile G, Blomström-Lundqvist C, ESC-EHRA Atrial Fibrillation Ablation Long-Term Registry investigators (2019) Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry. Europace 21(4):581–589CrossRefGoogle Scholar
- 29.Squara F, Zhao A, Marijon E, Latcu DG, Providencia R, Di Giovanni G, Jauvert G, Jourda F, Chierchia GB, De Asmundis C, Ciconte G, Alonso C, Grimard C, Boveda S, Cauchemez B, Saoudi N, Brugada P, Albenque JP, Thomas O (2015) Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicentre European evaluation. Europace. 17(5):718–724CrossRefGoogle Scholar
- 30.Bollmann A, Ueberham L, Schuler E, Wiedemann M, Reithmann C, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Zacharzowsky U, Ulbrich M, Wetzel U, Neuser H, Bode K, Kuhlen R, Hindricks G (2018) Cardiac tamponade in catheter ablation of atrial fibrillation: german-wide analysis of 21 141 procedures in the Helios atrial fibrillation ablation registry (SAFER). Europace. 20(12):1944–1951CrossRefGoogle Scholar