Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-134 - Multicenter Experience With Zero/low Fluoroscopic Atrial Fibrillation Ablation: (ID 108)

  D. Singh: Honoraria/Speaking/Consulting Fee - Biosense Webster, Inc..


Background: Fluoroscopy is frequently utilized for AF ablation but radiation exposure and ergonomic issues related to lead protection are substantial. The availability of 3D electroanatomic mapping systems and intracardiac ultrasound (ICE) have helped to reduce or eliminate fluoroscopy. We report the results of a multicenter experience utilizing a near-zero or zero fluoroscopic protocol for AF ablation.
Objective: To determine the safety and efficacy of a zero or near-zero fluoroscopic approach to AF ablation.
Methods: Retrospective analysis of zero fluoro or near-zero fluoro AF ablation was conducted at three participating centers. The CARTO® electroanatomic mapping system and intracardiac ultrasound (ICE) was utilized in all cases. Standard follow-up measures were undertaken following ablation. AF detection following ablation included the use of office ECG, ambulatory monitoring and, when appropriate, implantable loop recorders.
Results: 1348 patients underwent ablation for AF ablation at three participating centers. Median age was 66 years (IQR 59-72) ; 64% of patients were male. 46% of patients had PAF. The remainder were classified as either persistent or LSPAF. Median ablation time was 2160 seconds (IQR 1625-2776); median procedure time was 90 minutes (IQR 71-120). In addition to PVI, linear ablation was performed in 11.7% of cases (N= 157). 44% (N= 592) of cases were classified as zero-fluoro. The median fluoro time for cases classified as near-zero fluoro was 0.40 minutes (IQR 0.10-0.50). Overall complication rate was 0.7% (N= 9, 1 death from stroke, 2 stroke/TIA, 5 pericardial effusions, 1 gastroparesis, and 1 esophageal injury) Freedom from AF at 1 year (N = 521) was 83%.
Our multicenter experience demonstrates that zero or near-zero fluoroscopic AF ablation is achievable with an acceptable safety and efficacy profile.