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      Feasibility, Efficiency, and Safety of Zero-Fluoroscopy Catheter Interventions for Right-Sided Cardiac Arrhythmias Using Only Electroanatomic Mapping


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          Fluoroscopy is traditionally used for catheter interventions in electrophysiology but carries a long-term health risk. Besides additional invasive procedures to achieve zero-fluoroscopy (ZF) interventions, electroanatomic mapping may be an alternative to fluoroscopy without the need of additional procedures. We aimed to investigate the feasibility, safety, and efficiency of a ZF approach using only electroanatomic mapping (ZF) compared to a conventional fluoroscopic (CF) approach for patients with right sided cardiac arrhythmias.


          We performed a single centre retrospective cohort study of consecutive patients undergoing catheter interventions for electrophysiologic procedures from January 2019 to December 2020. Patients with left-sided arrhythmias, focal cryoablation, implanted endocardial devices, or additional interventions requiring fluoroscopy were excluded.


          202 patients underwent a ZF and 126 patients underwent a CF approach for right-sided cardiac arrhythmias. Apart from atrial fibrillation (ZF 16% vs. CF 9%, p = 0.044), baseline demographics were similar in both groups. Acute success rate was 100% in the ZF group and 97.9% in the CF group. Mean procedure time was lower in the ZF group (70 ± 36 vs. 87 ± 44 min, p = 0.0001), while ablation time (356 ± 324 vs. 320 ± 294 s, p = 0.157) was similar. Total complication rate was low in general (1.0 % major, 2% minor complications) and without a difference between both groups.


          A ZF approach using only electroanatomic mapping without additional invasive procedures to diagnose and treat right-sided cardiac arrhythmias is feasible, efficient, and safe.

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          Most cited references22

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          The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology.

          The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation, but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1-60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the key principle of radiation protection that: 'each patient should get the right imaging exam, at the right time, with the right radiation dose'.
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            Interventional cardiologists and risk of radiation-induced cataract: results of a French multicenter observational study.

            Interventional cardiologists (ICs) are exposed to X-rays and may be at risk to develop cataract earlier than common senile cataract. Excess risk of posterior subcapsular cataract, known as radiation-induced, was previously observed in samples of ICs from Malaysia, and Latin America. The O'CLOC study (Occupational Cataracts and Lens Opacities in interventional Cardiology) was performed to quantify the risk at the scale of France.
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              Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial.

              To compare the utility of non-fluoroscopic mapping systems (Carto and Ensite NavX) with that of conventional mapping in patients referred for catheter ablation of a wide variety of arrhythmias. Patients referred for catheter ablation (excluding atrial fibrillation, atypical atrial flutter, ventricular tachycardia in structural heart disease, and complete AV nodal ablation) were randomized equally to a procedure guided by Carto, Ensite NavX, or conventional mapping. A total of 145 patients were recruited (82 men, aged 49+/-16, range 18-85). In 19 patients, no ablation was performed, and in the remaining, typical atrial flutter, atrioventricular nodal re-entrant tachycardia, and atrioventricular re-entrant tachycardias [including Wolff-Parkinson-White (WPW)] accounted for 93% of ablations. Overall procedure time, immediate and short-term success, complication rate, and freedom from symptoms at follow-up were identical for all groups. NavX led to the least X-ray exposure: Navx vs. conventional, median (range): 4 (0-50) vs. 13 (2-46) min (P<0.001); NavX vs. Carto, median (range): 4 (0-50) vs. 6 (1-55) min (P=0.008). Both Carto and NavX increased disposable costs by 50% when compared with conventional (P<0.001). For typical atrial flutter, Carto and NavX reduced screening times without increasing procedure cost. If ablation was not performed, NavX was twice as expensive as Carto or conventional. Ensite NavX and Carto procedures have similar effectiveness and safety to a conventional approach; however, they both reduce X-ray exposure, with NavX producing a significantly greater effect than Carto. Although this benefit is achieved at a greater financial cost, there may be long-term benefits to catheter laboratory staff.

                Author and article information

                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                December 2022
                17 August 2022
                17 August 2022
                : 147
                : 5-6
                : 547-556
                [1] aDivision of Electrophysiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
                [2] bDivision of General Internal Medicine, Triemli Hospital, Zurich, Switzerland
                Author notes
                Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.

                : 2 January 2022
                : 8 August 2022
                : 2022
                Page count
                Figures: 4, Tables: 4, References: 20, Pages: 10
                No funding has been received in context to this study.
                Electrophysiology and Arrhythmia: Research Article

                zero-fluoro,electroanatomic mapping,fluoroscopy,ablation,electrophysiology


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