Abstract 2747: Fluoro-less Pulmonary Vein Isolation: Initial Clinical Experience
Introduction: For pulmonary vein isolation (PVI), a number of technological advances have reduced fluoroscopy time. However, the only imaging modalities completely free of radiation, ultrasound and MRI, are not sufficient to enable complex fluoroless procedures. We evaluated the feasibility and safety of performing completely fluoroless PVI by combining 3D electroanatomical mapping with ICE.
Methods: NavX mapping (St Jude Medical Inc) is able to visualize multiple electrodes in the heart and vasculature. A mapping catheter was used to create RA/CS geometries; a CS catheter was placed from femoral access. Then, ICE-guided transseptal puncture was performed. Using a deflectable sheath and a multippolar catheter, the LA-PV anatomy was rendered, occasionally with 3D-CT image integration.
Results: The patient cohort included 20 consecutive PAF pts (1 redo ablation): age 55±4 (23– 83), 15M/5F, LA size 4.1cm, EF 50%. RA/CS mapping required 6±5 min. Single (18 pts) or dual (2 pts) transseptal access was successfully achieved in all pts. The LA-PV anatomy was rendered using either a circular (14 pts) or penta-array (6 pts) catheter in 22±10 min; CT image integration was employed in 11 pts. Using irrigated RF energy, each pair of ipsilateral PVs were encircled to achieve electrical PVI using 48±19 lesions/pt; in the redo pt, only the reconnected RPVs were ablated. The procedure time was 250±77 min. There were no complications.
Conclusion: Completely fluoroless catheter ablation of paroxysmal AF is safely feasible with acceptable procedure times. This may prove to be particularly useful for pregnant or obese patients requiring catheter ablation.