P1405Minimal fluoroscopy atrial fibrillation catheter ablation: a prospective multicenter registry

Abstract

Background: Using electroanatomic mapping (EA) and intracardiac ultrasound (ICE), it may be possible to nearly eliminate fluoroscopy use during catheter ablation for atrial fibrillation (AF). To date, there has been no prospective multicenter evaluation of the safety and efficacy of a minimal fluoroscopy (MF) approach to catheter ablation of AF. Objectives: We hypothesize that catheter ablation for AF using MF techniques is safe and effective; we sought to demonstrate this through a prospective, multicenter registry. Methods: Four high-volume academic and private institutions with operators already proficient with MF catheter ablation of AF using ICE and CARTO were selected for participation. Patients aged 18-75 years, without severe heart failure, with symptomatic, drug refractory paroxysmal AF (PAF) or persistent AF (perAF) undergoing MF catheter ablation of AF are being consecutively enrolled across all centers (Feb 2016- present, enrollment goal >160). Operators use their preferred MF techniques, with reliance on EA mapping and ICE techniques. All ablation was performed using contact force externally irrigated catheters. Measured outcomes include acute pulmonary vein (PV) isolation, procedure time, fluoroscopy time and dose, ability of all procedure staff to remove lead during cases, and complications. Clinical follow-up will include standard clinical care, with office and Ambulatory ECG monitoring through 12 months. Results: To date, there are a total of 63 enrolled and 56 treated patients across all participating centers, age 62.3 +/- 7.6 years, 64.8% male, 58.5% PAF vs. 41.5% perAF. Mean Procedure time is 196 +/- 37.2 min, median fluoroscopy time 0.10 minutes (range 0-6.9 minutes), and median radiation dose 168.4 mGy (range 0- 64,380), with MD and staff complete lead removal in 80.4% of cases. 100 % of pulmonary veins were isolated, additional ablation beyond PVI was performed in 68.3%, with 0% serious complications. Conclusions: Preliminary results from the first prospective multicenter registry evaluating the safety and efficacy of minimal fluoroscopy catheter ablation of AF suggests this is an effective and safe procedural approach across multiple institutions.