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

Fei Hang, Liting Cheng, Zhuo Liang, Ruiqing Dong, Xinlu Wang, Ziyu Wang, Zefeng Wang, Yongquan Wu, Fei Hang, Liting Cheng, Zhuo Liang, Ruiqing Dong, Xinlu Wang, Ziyu Wang, Zefeng Wang, Yongquan Wu

Abstract

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.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2021 Fei Hang et al.

Figures

Figure 1
Figure 1
Transseptal puncture with fluoroscopy. (a) At the right anterior oblique (RAO) angle of 30°, a 10-polar diagnostic catheter was placed in the coronary sinus. (b) At the anterior posterior (AP) position, the long sheath was sent into the superior vena cava (SVC) through the guidewire. Then, we removed the guidewire and sent a transseptal needle into the long sheath. The distance between the tip of the long sheath and the tip of transseptal needle was about 1 cm. (c, d) Upon withdrawal of the long sheath and the transseptal needle together, the tip of the sheath was observed to jump twice. After jumping for the second time, the tip was pointing toward to the foramen ovale. (e) RAO 45° was used to confirm that the tip of the sheath was vertical to the atrial septum. (f) A transseptal needle was used to puncture the atrial septum. (g) Contrast medium was injected into LA through the needle, and a dark thick line was shown under fluoroscopy at the AP position. (h, i) We pushed dilator inside the long sheath through the transseptal needle into the LA. Then, the needle was withdrawn, and the long wire was placed in the left superior pulmonary vein.
Figure 2
Figure 2
Establishing the left atrium model with a PentaRay catheter in a patient in the F group.
Figure 3
Figure 3
Radiofrequency catheter ablation of paroxysmal atrial fibrillation accomplished in the F group.
Figure 4
Figure 4
Establishing the left atrium model with intracardiac echocardiography (ICE) and using electroanatomical mapping systems (EAMs) and ICE to confirm the location of the foramen ovale (shown by the arrow).
Figure 5
Figure 5
Radiofrequency catheter ablation of paroxysmal atrial fibrillation accomplished via zero-fluoroscopy transseptal puncture guided by EAM-ICE.

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