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Low-fluoroscopy atrial fibrillation ablation with contact force and ultrasound technologies: a learning curve

Authors Zei PC, Hunter TD, Gache LM, O'Riordan G, Baykaner T, Brodt CR

Received 24 July 2018

Accepted for publication 28 November 2018

Published 10 January 2019 Volume 2019:10 Pages 1—7

DOI https://doi.org/10.2147/POR.S181220

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Professor David Price


Paul C Zei,1 Tina D Hunter,2 Larry M Gache,2 Gerri O’Riordan,3 Tina Baykaner,3 Chad R Brodt3

1Cardiac Electrophysiology, Brigham and Women’s Hospital, Boston, MA, USA; 2Real World Evidence, CTI Clinical Trial and Consulting Services, Covington, KY, USA; 3Cardiovascular Medicine, Stanford University, Stanford, CA, USA

Background:
Fluoroscopy exposure during catheter ablation is a health hazard to patients and operators. This study presents the results of implementing a low-fluoroscopy workflow using modern contact force (CF) technologies in paroxysmal atrial fibrillation (PAF) ablation.
Methods: A fluoroscopy reduction workflow was implemented and subsequent catheter ablations for PAF were evaluated. After vascular access with ultrasound guidance, a THERMOCOOL SMARTTOUCH® Catheter (ST) was advanced into the right atrium. The decapolar catheter was placed without fluoroscopy. A double-transseptal puncture was performed under intracardiac echocardiography guidance. ST and mapping catheters were advanced into the left atrium. A left atrial map was created, and pulmonary vein (PV) isolation was confirmed via entrance and exit block before and after the administration of isoproterenol or adenosine.
Results: Forty-three patients underwent PAF ablation with fluoroscopy reduction workflow (mean age: 66±9 years; 70% male), performed by five operators. Acute success rate (PV isolation) was 96.5% of PVs. One case of pericardial effusion, not requiring intervention, was the only acute complication. Mean procedure time was 217±42 minutes. Mean fluoroscopy time was 2.3±3.0 minutes, with 97.7% of patients having < 10 minutes and 86.0% having < 5 minutes. A significant downward trend over time was observed, suggesting a rapid learning curve for fluoroscopy reduction. Freedom from any atrial arrhythmias without reablation was 80.0% after a mean follow-up of 12±3 months.
Conclusion: Low fluoroscopy time is achievable with CF technologies after a short learning curve, without compromising patient safety or effectiveness.

Keywords: atrial fibrillation, catheter ablation, workflow, contact force, low fluoroscopy

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