Electroanatomic guidance versus conventional fluoroscopy during transseptal puncture for atrial fibrillation ablation.
ablation
atrial fibrillation
atrial transseptal puncture
electroanatomic mapping
fluoroscopy
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
14
02
2020
revised:
23
06
2020
accepted:
06
07
2020
pubmed:
24
7
2020
medline:
29
7
2021
entrez:
24
7
2020
Statut:
ppublish
Résumé
Technological advancement in the setting of atrial fibrillation (AF) ablation has decreased radiation exposure and complications associated with the procedure. Yet, transseptal puncture (TSP) remains a challenging step that necessitates accurate guidance. We describe our experience performing TSP under electroanatomic (EA) guidance. The analysis included 145 consecutive EA-guided ablation procedures performed between June 2018 and April 2019 and 145 consecutive standard ablations performed before June 2018. EA guidance utilized the CARTO 3 three-dimensional mapping system to reconstruct anatomic and electrical characteristics of the right atrium and fossa ovalis. Patients with a history of previous cardiac surgery were excluded. For EA-guided procedures, the mean patient age was 60 ± 10 years, 75.2% were male, and 69.0% had paroxysmal AF. Similarly, the mean age for conventional procedures was 60 ± 11 years, 71.0% were male, and 71.7% had paroxysmal AF. The fossa ovalis was detected as a region of low voltage, <0.75 mV. EA guidance yielded shorter fluoroscopy times (EA vs. conventional, 3.6 ± 2.5 vs. 13.5 ± 10.5 min; p < .001) and a lower dose area product than conventional guidance (13 ± 11 Gy* cm During AF ablation, TSP with EA guidance facilitated safe access to the left atrium while reducing radiation risk to both patients and operators.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2607-2613Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Klein LW, Miller DL, Balter S, et al. Occupational health hazards in the interventional laboratory: time for a safer environment. Radiology. 2009;250:538-544.
Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation; Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies. Health Risks From Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press; 2006.
Bigelow AM, Smith G, Clark JM. Catheter ablation without fluoroscopy: current techniques and future direction. J Atr Fibrillation. 2014;6:1066.
Bulava A, Hanis J, Eisenberger M. Catheter ablation of atrial fibrillation using zero-fluoroscopy technique: a randomized trial. Pacing Clin Electrophysiol. 2015;38:797-806.
Reddy VY, Morales G, Ahmed H, et al. Catheter ablation of atrial fibrillation without the use of fluoroscopy. Heart Rhythm. 2010;7:1644-1653.
McCauley MD, Patel N, Greenberg SJ, Molina-Razavi JE, Safavi-Naeini P, Razavi M. Fluoroscopy-free atrial transseptal puncture. Eur J Arrhythm Electrophysiol. 2016;2:57-61.
Elkiran O, Akdeniz C, Karacan M, Tuzcu V. Electroanatomic mapping-guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy. Pacing Clin Electrophysiol. 2019;42:453-457.
Dong J, Dickfeld T, Dalal D, et al. Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:459-466.
Bourier F, Reents T, Ammar-Busch S, et al. Transseptal puncture guided by CT-Derived 3D-augmented fluoroscopy. J Cardiovasc Electrophysiol. 2016;27:369-372.
De Ponti R, Zardini M, Storti C, Longobardi M, Salerno-Uriarte JA. Trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. Eur Heart J. 1998;19:943-950.
Casella M, Dello Russo A, Pelargonio G, et al. Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial. Europace. 2016;18:1565-1572.
Bartel T, Müller S, Biviano A, Hahn RT. Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn. Eur Heart J. 2014;35:69-76.
Koca S, Akdeniz C, Tuzcu V. Transseptal puncture for catheter ablation in children. Pediatr Cardiol. 2019;40:799-804.
Stabile G, Scaglione M, del Greco M, et al. Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system: a multicentre experience. Europace. 2012;14:60-65.
Huo Y, Christoph M, Forkmann M, et al. Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: a prospective, randomized, single-blind, and controlled study. Heart Rhythm. 2015;12:1945-1955.
Ferreira Martins JD, Anderson RH. The anatomy of interatrial communications-what does the interventionist need to know? Cardiol Young. 2000;10:464-473.
Faletra FF, Biasco L, Pedrazzini G, et al. Echocardiographic-fluoroscopic fusion imaging in transseptal puncture: a new technology for an old procedure. J Am Soc Echocardiogr. 2017;30:886-895.
Faletra FF, Leo LA, Paiocchi VL, et al. Revisiting anatomy of the interatrial septum and its adjoining atrioventricular junction using noninvasive imaging techniques. J Am Soc Echocardiogr. 2019;32:580-592.
Anderson RH, Webb S, Brown NA. Clinical anatomy of the atrial septum with reference to its developmental components. Clin Anat. 1999;12:362-374.
Derejko P, Hasiec A, Bardyszewski A, et al. Distances between transseptal puncture site and anatomical landmarks. J Cardiovasc Electrophysiol. 2019;30:2841-2848.
Sawhney V, Breitenstein A, Watts T, et al. A novel technique for performing transseptal puncture guided by a non-fluoroscopic 3D mapping system. Pacing Clin Electrophysiol. 2019;42:4-12.
Sairaku A, Yoshida Y, Nakano Y, et al. Who is the operator, that is the question: a multicentre study of catheter ablation of atrial fibrillation. Europace. 2016;18:1352-1356.
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(18):1609-1678.