Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias

• Published in: Europace (London, England) England), 2015-06, Vol.17 (6), p.928-937
• Main Authors: Christoph, Marian, Wunderlich, Carsten, Moebius, Stefanie, Forkmann, Mathias, Sitzy, Judith, Salmas, Jozef, Mayer, Julia, Huo, Yan, Piorkowski, Christopher, Gaspar, Thomas
• Format: Article
• Language: English
• Subjects: Accessory Atrioventricular Bundle - surgery; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac - surgery; Atrial Fibrillation - surgery; Atrial Flutter - surgery; Catheter Ablation - methods; Cohort Studies; Female; Fluoroscopy - methods; Fluoroscopy - statistics & numerical data; Humans; Imaging, Three-Dimensional - methods; Intraoperative Care - methods; Male; Middle Aged; Operative Time; Radiation Dosage; Radiation Exposure - statistics & numerical data; Retrospective Studies; Surgery, Computer-Assisted - methods; Tachycardia, Ectopic Atrial - surgery; Tachycardia, Ventricular - surgery; Ventricular Premature Complexes - surgery
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euu334

Despite the use of established 3D-mapping systems, invasive electrophysiological studies and catheter ablation require high radiation exposure of patients and medical staff. This study investigated whether electroanatomic catheter tracking in prerecorded X-ray images on top of an existing 3D-mapping system has any impact on radiation exposure. Two hundred and ninety-five consecutive patients were either ablated with the guidance of the traditional CARTO-3 system (c3) or with help of the CARTO-UNIVU system (cU): [typical atrial flutter (AFL) n = 58, drug refractory atrial fibrillation (AF) n = 81, ectopic atrial tachycardia (EAT) n = 37, accessory pathways (APs) n = 22, symptomatic, idiopathic premature ventricular complexes (PVCs) n = 56, ventricular tachycardias (VTs) n = 41]. The CARTO-UNIVU allowed a reduction in radiation exposure: fluoroscopy time: AFL c3: 8.6 ± 0.8 min vs. cU: 2.9 ± 0.3 min, P < 0.001; AF c3: 16.0 ± 1.3 min vs. cU: 6.4 ± 0.9 min, P < 0.001; EAT c3: 23.4 ± 3.1 min vs. cU: 9.7 ± 1.7 min, P < 0.001; AP c3: 7.1 ± 1.2 min vs. cU: 6.0 ± 1.5 min, P = 0.59; PVCs c3: 17.6 ± 2.3 min vs. cU: 15.2 ± 2.8 min, P = 0.52; VT c3: 31.4 ± 3.4 min vs. cU: 17.5 ± 2.4 min, P = 0.003. Corresponding to the fluoroscopy time the fluoroscopy dose was also reduced significantly. These advantages were not at the cost of increased procedure times, periprocedural complications, or decreased acute ablation success rates. In a wide spectrum of cardiac arrhythmias, and especially in AF and VT ablation, fluoroscopy integrated 3D mapping contributed to a dramatic reduction in radiation exposure without prolonging procedure times and compromising patient's safety. That effect, however, could not be maintained in patients with APs and PVCs.