Catheter Ablation of Atrial Fibrillation Without Radiation Exposure Using A 3D Mapping System

Abstract

Transcatheter ablation procedures have been traditionally performed under fluoroscopic guidance. However, x-ray exposure is afflicted by the risk of developing malignancies as well as other deterministic effects of radiation. For this reason, radiation doses in the interventional laboratory should be reduced "As Low As Reasonably Achievable", with respect to the safety of the patients and the medical staff. This is of utmost importance in atrial fibrillation (AF) ablations, which are usually lengthy procedures. With the improvement of technology, the development of additional imaging tools and the widespread of 3D electroanatomic mapping systems (EAM), near-zero fluoroscopy AF ablation procedure is becoming a reality, limiting fluoroscopy use mainly to guide transseptal puncture. In the present paper we reviewed the risks to health related to x-ray exposure and we discussed the current state of knowledge of catheter ablation of AF without fluoroscopy in the 3D EAM system era.

Figures

Figure 1.. A – upper panel: Carto 3 electroanatomic reconstruction of the left atrium obtained with the mapping catheter (postero-anterior view). A – lower panel: MRI of the left atrium. B – left panel: NavX electroanatomic reconstruction of the left atrium obtained with the mapping catheter (antero-posterior view). B – right panel: MRI of the left atrium. With both EAM systems, the reconstructed cardiac anatomy is very similar to that obtained with MRI

Figure 2.. The Carto3 electroanatomic reconstruction obtained with the mapping catheters and the MRI are merged (postero-anterior and right anterior oblique views respectively); the system allows a reliable visualization of all the catheters inside the heart chamber. Yellow catheter, ablation catheter inside the left atrium; blue catheter, circular mapping catheter inside the left superior pulmonary vein