Zero-fluoroscopy cryothermal ablation of atrioventricular nodal re-entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

2017 ◽  
Vol 29 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Blerim Luani ◽  
Bernhard Zrenner ◽  
Maksim Basho ◽  
Conrad Genz ◽  
Thomas Rauwolf ◽  
...  
Keyword(s):  
Intracardiac Echocardiography ◽  
Cryothermal Ablation ◽  
Zero Fluoroscopy

scholarly journals A New Technique for Zero Fluoroscopy Atrial Fibrillation Ablation Without the Use of Intracardiac Echocardiography

2018 ◽  
Vol 4 (12) ◽  
pp. 1647-1648 ◽  
Author(s):  
Silvia Guarguagli ◽  
Ilaria Cazzoli ◽  
Aleksander Kempny ◽  
Michael A. Gatzoulis ◽  
Sabine Ernst
Keyword(s):  
Atrial Fibrillation ◽  
Intracardiac Echocardiography ◽  
Atrial Fibrillation Ablation ◽  
New Technique ◽  
A New Technique ◽  
Zero Fluoroscopy

scholarly journals Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Fei Hang ◽  
Liting Cheng ◽  
Zhuo Liang ◽  
Ruiqing Dong ◽  
Xinlu Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Intracardiac Echocardiography ◽  
Transseptal Puncture ◽  
Electroanatomical Mapping ◽  
Curative Effect ◽  
Significant Difference ◽  
Zero Fluoroscopy

Aims. 3D electroanatomical mapping combined with intracardiac echocardiography- (EAM-ICE-) guided transseptal puncture has been proven safe and effective during the radiofrequency catheter ablation (RFCA) procedure used to treat paroxysmal atrial fibrillation (PAF). In this study, we aimed to compare the curative effect and safety of RFCA via F (fluoroscopy) and zero-fluoroscopy transseptal puncture guided by EAM-ICE in patients with PAF. Methods and Results. A prospective study in which 110 patients with PAF were included and assigned to two groups was conducted. Fifty-five (50%) patients were enrolled in the EAM-ICE group, whereas the other 55 (50%) patients were enrolled in the F group. There were no significant differences in baseline characteristics between the two groups. The transseptal duration time was longer in the EAM-ICE group (19.8 ± 3.0 min vs. 8.6 ± 1.2 min, p ≤ 0.01 ); however, fluoroscopy was not used in the EAM-ICE group compared with the F group (0 mGy vs. 109.1 ± 57.9 mGy). Similarly, there was also no significant difference in the recurrence rate of atrial fibrillation between the EAM-ICE and F groups (25.5% vs. 18.2%, p = 0.356 ). Conclusion. RFCA via EAM-ICE-guided zero-fluoroscopy transseptal puncture in patients with PAF is safe and effective for long-term follow-up.

scholarly journals Transjugular approach for zero-fluoroscopy catheter ablation of the right anterolateral accessory pathway

2019 ◽  
Vol 88 (9-10) ◽  
pp. 464-67
Author(s):  
Tine Prolič Kalinšek ◽  
David Žižek ◽  
Matevž Jan
Keyword(s):  
Catheter Ablation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Accessory Pathway ◽  
Three Dimensional ◽  
Vena Cava ◽  
Intracardiac Echocardiography ◽  
Congenital Agenesis ◽  
The Right ◽  
Zero Fluoroscopy

We present a case of successful zero-fluoroscopy catheter ablation (CA) of the right anterolateral accessory (AP) pathway via a transjugular approach in an 18-year-old patient with a congenital agenesis of inferior vena cava (IVC). Three-dimensional (3D) electroanatomic mapping (EAM) system and intracardiac echocardiography (ICE) were used to navigate the catheters in the heart.

scholarly journals Fluoroless Catheter Ablation of Cardiac Arrhythmias

2018 ◽  
Vol 12 (2) ◽  
pp. 107
Author(s):  
Sandeep K Goyal ◽  
Bruce S Stambler ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Ionizing Radiation ◽  
Health Risks ◽  
Cardiac Arrhythmias ◽  
Intracardiac Echocardiography ◽  
Protective Equipment ◽  
3D Mapping ◽  
Mapping Systems ◽  
Zero Fluoroscopy ◽  
Arrhythmia Management

Catheter ablation is the mainstay of cardiac arrhythmia management, and the number of these procedures carried out is continuing to grow. Fluoroscopy has been integral to these procedures to ensure safe catheter manipulation. Unfortunately, exposure to ionizing radiation is associated with several health risks to patients and personnel. The personal protective equipment used to reduce these risks is associated with incomplete protection and orthopedic risks to physicians and other staff. 3D mapping systems and intracardiac echocardiography, if used properly, can significantly reduce the use of fluoroscopy. The study describes a zero-fluoroscopy approach to cardiac ablation of AF and other arrhythmias using 3D mapping and intracardiac echocardiography to reduce or eliminate exposure to ionizing radiation and orthopedic risks to personnel.

scholarly journals Zero-fluoroscopy ablation in patients with cardiac electronic implantable devices

2021 ◽  
Author(s):  
Keiko Shimamoto ◽  
Kennichiro Yamagata ◽  
Akinori Wakamiya ◽  
Nobuhiko Ueda ◽  
Tsukasa Kamakura ◽  
...  
Keyword(s):  
Intracardiac Echocardiography ◽  
High Rate ◽  
Supraventricular Arrhythmia ◽  
Limited Data ◽  
3 Dimensional ◽  
Total Procedure Time ◽  
Mapping System ◽  
Procedural Success ◽  
Total Procedure ◽  
Zero Fluoroscopy

Introduction: Utilizing a 3-dimensional (3-D) mapping system and intracardiac echocardiography (ICE) has allowed ablation procedures with less or without fluoroscopy; however, there is limited data for patients with cardiac electronic implantable device (CIED) leads regarding the suspected risk of lead injury. Therefore, we sought to explore technics to perform safe trans-septal approach and catheter manipulation technique in patients with CIED leads. Methods and Results: This study comprised 68 consecutive patients (45 [66.2%] males, median [interquartile range] 73 [68–77] years old) with CIED who underwent catheter ablation for supraventricular tachycardia, 16 without fluoroscopy (zero-fluoro group) and 52 with fluoroscopy (conventional-fluoro group), between July 2019 and April 2021. All procedures were performed under a 3-D mapping system and ICE guidance. We compared the differences in treatment and development of complications between the two groups. The procedures were mainly atrial fibrillation (73.6%) and atrial tachycardia. The median time from venipuncture to trans-septal procedure (zero-fluoro vs. conventional-fluoro group: 27.0 min vs. 23.5 min, P=0.71) and total procedure time (215 min vs. 172 min, P=0.55) were not different between the two groups. The acute procedural success rate (100% vs. 98.1%, P=1.00) and reduction of atrial high-rate episodes at 6 months (3.2 [0.3–93.9]% vs. 1.0 [0.0–14.9]%, P=0.33) did not differ between the two groups. No patient showed lead-related complications in both groups. Conclusions: Zero-fluoro ablation for supraventricular arrhythmia using 3-D mapping and ICE in patients with CIED leads was feasible under careful catheter manipulation.

scholarly journals Outcome and safety of intracardiac echocardiography guided left atrial appendage closure within zero-fluoroscopy atrial fibrillation ablation procedures

2021 ◽  
Author(s):  
yi he chen ◽  
Liangguo Wang ◽  
Xiaodong Zhou ◽  
ying fang ◽  
Lan Su ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Intracardiac Echocardiography ◽  
Atrial Appendage ◽  
Adverse Event Rate ◽  
Left Atrial Appendage Closure ◽  
Zero Fluoroscopy

Background: Simultaneous atrial fibrillation (AF) catheter ablation and left atrial appendage closure (LAAC) is sometimes recommended for both rhythm control and stroke prevention. However, the advantages of intracardiac echocardiography (ICE) guidance for this combined procedure have been scarcely reported. To evaluate the clinical outcomes and safety of ICE guided LAAC within a zero-fluoroscopy catheter ablation procedure. Methods and Results:From April 2019 to April 2020, 56 patients with symptomatic AF underwent concomitant catheter ablation and LAAC. ICE with a multi-angled imaging protocol mimicking the TEE echo windows was used to guide LAAC. Successful radiofrequency catheter ablation and LAAC was achieved in all patients. Procedure-related adverse event rate was 3.6%. During the 12-month follow-up, 77.8% of patients became free of arrhythmia recurrences and oral anticoagulants were discontinued in 96.4% of patients. No ischemic stroke occurred despite two cases of device-related thrombosis versus an expected stroke rate of 4.8% based on the CHA2DS2-VASc score. The overall major bleeding events rate was 1.8%, which represented a relative reduction of 68% versus an expected bleeding rate of 5.7% based on the HAS-BLED score of the patient cohort. The incidence of iatrogenic atrial septal defect secondary to a single transseptal access dropped from 57.9% at 2 months to 4.2% at 12 months TEE follow-up. Conclusion:The combination of catheter ablation and LAAC under ICE guidance was safe and effective in AF patients with high stroke risk. ICE with our novel protocol was technically feasible for comprehensive and systematic assessment of device implantation.

P377Zero-fluoroscopy ablation with ultrasound-guided sheath insertion

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Kawakami ◽  
N Saitoh ◽  
Y Asukai ◽  
S Wada ◽  
H Sasaki ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Contact Force ◽  
Femoral Vein ◽  
Posterior Wall ◽  
Intracardiac Echocardiography ◽  
Ultrasound Guided ◽  
Fluoroscopic Time ◽  
Force Monitoring ◽  
Sheath Insertion ◽  
Zero Fluoroscopy

Abstract Background Radiation exposure during catheter ablation procedures is a risk for both the patient and electrophysiology staff. Recently, the feasibility and effectiveness of zero-fluoroscopy ablation have been shown. However, ensuring a safe sheath insertion through the venous system toward the heart is a concern in catheter ablation using the zero-fluoroscopy technique.  Purpose The objective of this study was to confirm feasibility and safety for zero-fluoroscopy ablation using ultrasound-guided sheath insertion. Methods Zero-fluoroscopy catheter ablation was performed in 220 patients (185 patients with atrial fibrillation (AF), 26 patients with supraventricular tachycardia (SVT), and nine patients with ventricular arrhythmias (VA)) using a 3-dimensional electro-anatomical mapping system, contact force monitoring, and intracardiac echocardiography (ICE) imaging. In all cases, ultrasound-guided sheath insertion was performed through the femoral vein. In 6 cases of VA, the retrograde approach through the femoral artery was performed with ICE imaging and contact-force monitoring. The endpoint of ablation for AF was pulmonary vein ablation in all cases and addition of left atrial posterior wall isolation in persistent AF cases. The endpoint of ablation for SVT and VA was noninducibility after ablation. Results The endpoints of ablation were achieved in all cases. The fluoroscopic time during ablation procedures was 0 seconds. There were two complications (one cardiac tamponade and one acute heart failure). There were no complications related to sheath insertion.  Conclusions Zero-fluoroscopy catheter ablation with ultrasound-guided sheath insertion may be feasible and can be performed safely. This method eliminates exposure radiation safely, which is a concern of zero-fluoroscopy endocardial catheter ablation.

scholarly journals Zero-Fluoroscopy Cardiac Ablation: Technology Is Moving Forward in Complex Procedures—A Novel Workflow for Atrial Fibrillation

Biology ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1333
Author(s):  
Matteo Bertini ◽  
Graziella Pompei ◽  
Paolo Tolomeo ◽  
Michele Malagù ◽  
Alessio Fiorio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gold Standard ◽  
Intracardiac Echocardiography ◽  
The Other ◽  
Transseptal Puncture ◽  
Healthcare Staff ◽  
Af Ablation ◽  
Mapping System ◽  
Long Time ◽  
Zero Fluoroscopy

Background and Rationale. A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, in particular to guide the transseptal puncture. Main results and Implications. We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two cases, one with paroxysmal AF and the other one with persistent AF during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.

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