P315Recent advances in 3D mapping systems together with intracardiac echocardiography imaging allow exclusion of fluoroscopy imaging in complex atrial fibrillation ablation procedures

Abstract

Introduction: Recent advances in 3D mapping systems, such as simultaneous visualization of multiple catheters and contact force measurement (CFM), have allowed a significant reduction in fluoroscopic times during radiofrequency ablation (RFA) procedures. Aims: To prove that RFA of paroxysmal atrial fibrillation (PAF) using the CARTO3 system and intracardiac echocardiography (ICE) can be easily and safely performed without fluoroscopy imaging. Methods: Patients with PAF were randomized to undergo either fluoroscopically guided pulmonary vein isolation (PVI) (X+) or PVI with no fluoroscopy (X-). In the zero-fluoroscopy group, catheter placement, transseptal puncture, left atrial (LA) geometry reconstruction and PVI was accomplished solely using ICE imaging and CARTO mapping. Results: Forty patients were included in each group. The patients did not differ in any clinical or demographic characteristics. The total procedure duration and RF application time in both the X- and X+ groups were comparable (92.5±22.9 min vs. 99.9±15.9 min, p=0.11 and 1785±548 s vs. 1755±450 s, p=0.79, respectively). Zero fluoroscopic time was achieved in all patients in the X- group with the exception of one patient, where 8 s of fluoroscopy was needed to assess proper position of the guide-wire in the femoral vein. No procedure-related complications were recorded in either patient group during the 30-day follow-up. Conclusion: RFA using ICE imaging and the CARTO3 mapping system with CFM can eliminate fluoroscopy in patients undergoing PVI. The zero fluoroscopy approach does not compromise patient safety and does not affect overall procedure duration, RF application time, and acute efficacy.