+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping



Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping



Circulation. Arrhythmia and Electrophysiology 2(6): 611-619



Catheter ablation of atrial fibrillation is currently guided by x-ray fluoroscopy. The associated radiation risk to patients and medical staff may be significant. We report an atrial fibrillation ablation technique using intracardiac echocardiography (ICE) and electroanatomic mapping without fluoroscopy. Twenty-one patients with atrial fibrillation (age, 42 to 73 years; 14 male; 14 paroxysmal, 7 persistent; body mass index, 26 to 38) underwent ablation. A decapolar catheter was advanced through the left subclavian vein until stable coronary sinus electrograms appeared on all electrodes. Two 9F sheaths were advanced transfemorally over a guide wire to the right atrium. A rotational ICE catheter was advanced through a deflectable sheath. Double transseptal puncture was performed with ICE guidance and facilitated by electrocautery. A 3D MRI left atrial image was registered to the ostia of the pulmonary veins using ICE. Catheter ablation was performed using ICE and electroanatomic mapping navigation. In 19 cases, no fluoroscopy was used and the staff did not wear protective lead. In 2 cases, 2 to 16 minutes of fluoroscopy was used to assist transseptal puncture. Median procedure time was 208 (188 to 221) minutes; coronary sinus cannulation took 5 (2 to 26) minutes; double transseptal took 26 (17 to 40) minutes; left atrial ablation time was 103 (90 to 127) minutes. All patients underwent circumferential pulmonary vein ablation and 8 patients underwent additional left atrial ablation. There were no procedure-related complications. Catheter ablation of atrial fibrillation without fluoroscopy is feasible and merits further attention. This technique may be especially helpful in preventing x-ray exposure in children, pregnant women, and obese patients undergoing left atrial ablation.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 051972423

Download citation: RISBibTeXText

PMID: 20009075

DOI: 10.1161/circep.109.872093


Related references

Catheter ablation of focal atrial tachycardia from the aortic cusp: the role of electroanatomic mapping and intracardiac echocardiography. Pacing and Clinical Electrophysiology 36(1): E19-E22, 2013

Electroanatomic catheter mapping and ablation of the inferior isthmus in atrial flutter Contemporary ablation without fluoroscopy?. European Heart Journal 20(ABSTR SUPPL ): 327, 1999

Electroanatomic Mapping and Transoesophageal Echocardiography for near Zero Fluoroscopy during Complex Left Atrial Ablation. Heart, Lung and Circulation 25(7): 652-660, 2017

Three-dimensional intracardiac echocardiography of pulmonary vein anatomy and location of circular mapping catheter in ablation of atrial fibrillation. European Heart Journal 23(Abstract Suppl.): 256, August-September, 2002

Electroanatomic mapping of the right atrium with a right atrial basket catheter and three-dimensional intracardiac echocardiography. Pacing and Clinical Electrophysiology 27(3): 318-326, 2004

P315Recent advances in 3D mapping systems together with intracardiac echocardiography imaging allow exclusion of fluoroscopy imaging in complex atrial fibrillation ablation procedures. Ep Europace 19(Suppl_3): iii50-iii51, 2017

Electroanatomic mapping-guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy. Pacing and Clinical Electrophysiology 2019, 2019

The use of intracardiac echocardiography during atrial fibrillation ablation to help guide circular mapping catheter placement and to monitor pulmonary vein flow. Circulation 104(17 Suppl.): II 476, October 23, 2001

A New Technique for Zero Fluoroscopy Atrial Fibrillation Ablation Without the Use of Intracardiac Echocardiography. Jacc. Clinical Electrophysiology 4(12): 1647-1648, 2018

Transseptal activation during left atrial pacing in humans: electroanatomic mapping using a noncontact catheter and the intracardiac echocardiography. Journal of Interventional Cardiac Electrophysiology 6(2): 149-159, 2002

Three-dimensional electroanatomic mapping systems in catheter ablation of atrial fibrillation. Circulation Journal 74(1): 18-23, 2010

Electroanatomic mapping system (CARTO) to perform catheter ablation of atrial fibrillation. Archivos de Cardiologia de Mexico 76 Suppl 2: S196-S199, 2006

Radiofrequency ablation of paroxysmal atrial fibrillation with the new irrigated multipolar nMARQ ablation catheter: verification of intracardiac signals with a second circular mapping catheter. Heart Rhythm 11(4): 559-565, 2014

Near zero fluoroscopy radiation exposure during successful catheter ablation of atrial tachycardia from the non-coronary aortic cusp using 3-dimentional electroanatomic mapping system. Anadolu Kardiyoloji Dergisi 14(6): 556-557, 2016

Intracardiac echocardiography during catheter ablation of atrial fibrillation. Europace 10 Suppl 3: Iii42-7, 2008