SAFETY AND EFFICACY OF MINIMAL FLUOROSCOPY APPROACH FOR CATHETER ABLATION IN ATRIAL FIBRILLATION: A MULTI CENTER, PROSPECTIVE REGISTRY
CCC ePoster Library. Quadros K. 10/26/19; 280510; 275
Dr. Kenneth Quadros
Dr. Kenneth Quadros
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Abstract
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BACKGROUND: Catheter ablation (CA) for atrial fibrillation is an effective approach for treatment of symptomatic, drug-refractory atrial fibrillation (AF). Catheter-based electrophysiology procedures have traditionally relied upon fluoroscopic imaging to guide catheter movement and placement. With recent advances is electro-anatomical mapping (EAM) technology and intracardiac echocardiography (ICE) there is reduced reliance on fluoroscopy. We sought to determine safety and efficacy of minimal fluoroscopy approach in AF CA.

METHODS AND RESULTS: Five centers in USA where physicians already proficient in a low-fluoroscopy approach to AF ablation and with a high volume of AF ablation procedures (>100 cases per annum) were identified. 6 primary operators participated. Between March 2016 and March 2018, 162 patients (18-75 years) referred for catheter ablation of symptomatic, drug-refractory paroxysmal or persistent AF, meeting guideline recommendations for catheter ablation of AF, were identified and enrolled. Data on 160 patients was available. We evaluated baseline characteristics, acute procedural outcomes and complications in addition to follow up data at 1 year. Specific techniques and technologies used were at the operators' discretion, save use of an electroanatomic mapping system (Carto, Biosense Webster) and intracardiac echocardiography (ICE). Continuous variables are analyzed as mean±standard deviation (SD). Categorical variables are analyzed as numbers or percentages. Patients were primarily male (62.5%), mean age 62±9 years, had paroxysmal AF (65.5%) with mean LV ejection fraction 58% ±9%. 26 (16.3%) patients were undergoing a repeat ablation. 100 (63%) procedures were performed with zero fluoroscopy (image 1). Mean fluoroscopy time was 1.7min± 2.8min. Mean procedure duration 195min ± 35 min. Acute pulmonary vein isolation was achieved in 153 patients (96%) with 1.8% acute procedural complication rate. 1 year follow up data available for 152 (93%) patients and mean follow time was 1.3±1.8months. 118 (76%) patients were free of arrhythmia at 1 year follow up. Late (1 year) complication rate remained low at 2.6% (table 1).

CONCLUSION: This is the first systematic, multi-center, prospective evaluation of a minimal fluoroscopy approach to catheter ablation of AF. Fluoroscopy utilization was significantly lower than historical controls, with further reduction seen overall across centers and operators over the course of the enrollment period. Overall procedure times were also comparable to historically reported times. Acute and long-term clinical outcomes were also equivalent to historical controls with low complication rate. Minimal fluoroscopy approach was found to be both safe and effective.
BACKGROUND: Catheter ablation (CA) for atrial fibrillation is an effective approach for treatment of symptomatic, drug-refractory atrial fibrillation (AF). Catheter-based electrophysiology procedures have traditionally relied upon fluoroscopic imaging to guide catheter movement and placement. With recent advances is electro-anatomical mapping (EAM) technology and intracardiac echocardiography (ICE) there is reduced reliance on fluoroscopy. We sought to determine safety and efficacy of minimal fluoroscopy approach in AF CA.

METHODS AND RESULTS: Five centers in USA where physicians already proficient in a low-fluoroscopy approach to AF ablation and with a high volume of AF ablation procedures (>100 cases per annum) were identified. 6 primary operators participated. Between March 2016 and March 2018, 162 patients (18-75 years) referred for catheter ablation of symptomatic, drug-refractory paroxysmal or persistent AF, meeting guideline recommendations for catheter ablation of AF, were identified and enrolled. Data on 160 patients was available. We evaluated baseline characteristics, acute procedural outcomes and complications in addition to follow up data at 1 year. Specific techniques and technologies used were at the operators' discretion, save use of an electroanatomic mapping system (Carto, Biosense Webster) and intracardiac echocardiography (ICE). Continuous variables are analyzed as mean±standard deviation (SD). Categorical variables are analyzed as numbers or percentages. Patients were primarily male (62.5%), mean age 62±9 years, had paroxysmal AF (65.5%) with mean LV ejection fraction 58% ±9%. 26 (16.3%) patients were undergoing a repeat ablation. 100 (63%) procedures were performed with zero fluoroscopy (image 1). Mean fluoroscopy time was 1.7min± 2.8min. Mean procedure duration 195min ± 35 min. Acute pulmonary vein isolation was achieved in 153 patients (96%) with 1.8% acute procedural complication rate. 1 year follow up data available for 152 (93%) patients and mean follow time was 1.3±1.8months. 118 (76%) patients were free of arrhythmia at 1 year follow up. Late (1 year) complication rate remained low at 2.6% (table 1).

CONCLUSION: This is the first systematic, multi-center, prospective evaluation of a minimal fluoroscopy approach to catheter ablation of AF. Fluoroscopy utilization was significantly lower than historical controls, with further reduction seen overall across centers and operators over the course of the enrollment period. Overall procedure times were also comparable to historically reported times. Acute and long-term clinical outcomes were also equivalent to historical controls with low complication rate. Minimal fluoroscopy approach was found to be both safe and effective.
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