Contact Force–Controlled Zero-Fluoroscopy Catheter Ablation of Right-Sided and Left Atrial Arrhythmia Substrates
Can radiofrequency catheter ablation (RFCA) procedures be performed safely without the use of fluoroscopy?
Atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway, typical atrial flutter, focal atrial tachycardia, ventricular arrhythmias arising in the outflow tract, or idiopathic paroxysmal atrial fibrillation was ablated in 18 adults and 12 pediatric patients using an irrigated-tip catheter with an integrated force sensor and an electroanatomical mapping system, without fluoroscopy. Transseptal puncture was guided by transesophageal echocardiography (TEE). Contact force during ablation was limited to 20 g for AVNRT and 40 g for other substrates.
The ablation procedure was successful without the use of fluoroscopy in 29/30 patients (97%). Transseptal puncture was accomplished successfully by TEE guidance in 7/8 patients and required fluoroscopy in one patient. The mean procedure time was 2.8 hours. The only complication was transient Mobitz I atrioventricular nodal block. There were no arrhythmia recurrences at a mean of 6.2 months of follow-up.
The authors concluded that catheter ablation of various arrhythmias can be accomplished safely and effectively without fluoroscopy using a contact force-sensing catheter and an electroanatomical mapping system.
Limiting radiation exposure as much as possible is important both for patients and operators. The amount of fluoroscopy can be markedly reduced by reliance on an electroanatomical mapping system for guidance during catheter navigation. What is unclear from this study is the extent to which the contact force-sensing catheter increased the safety or efficacy of the ablation procedures.
Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Fluoroscopy, Follow-Up Studies, Heart Rate, Tachycardia, Atrioventricular Block, Punctures, Atrial Fibrillation, Accessory Atrioventricular Bundle, Catheter Ablation, Resin Cements, Echocardiography
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