Abstract 16955: Training EP Fellows to Use Low Fluoroscopy Techniques for Atrial Fibrillation Ablation
Introduction: Despite the use of 3D electroanatomic mapping (EAM) systems, atrial fibrillation (AF) ablation still requires high radiation exposure and fluoroscopy (FL) times. Using CARTO UnivU (CU), FL images are imported to create a background over which virtual catheters are displayed and then fused with EAM of the left atrium, thus simulating FL without further radiation. We report techniques to train EP fellows in low FL left atrial ablation (LA) using CU, phased-array intracardiac ultrasound (ICE) and force-sensing (FS) catheters.
Methods: We performed 52 ablations for AF and left atrial flutter (LAF) from Feb to Nov 2015 in which the EP fellow was primary operator. AP and LAO CU images were obtained and ICE was advanced from the left femoral vein to the right atrium, to image the SVC. The guidewire and transseptal long sheath were positioned in the SVC under ICE guidance. We then performed pullback to the fossa under ICE guidance until tenting of the fossa was observed. Transseptal puncture was performed using ICE and FL in the LAO projection. A second transseptal sheath was placed using the same technique. EAM of the left atrium was performed using a multipolar mapping catheter (Pentarray or LassoNav). A coronary sinus catheter was advanced without FL, using both CU and ICE. Following transseptal puncture, all catheter manipulation was done with CU, ICE and the force vector of the FS catheter. At this point, lead protective wear was no longer needed.
Results: We performed 52 ablations: 47 for AF (30 persistent) and 5 for LAF. The mean age was 66 yrs., 64% were male, and 12% had implanted devices. Mean procedure time was 225 (120 - 390) min with 40 (14 - 68) min of RF ablation. Mean FL time was 4.2 (0.5 - 8.4) min and mean dose of 22 (9-124) cGy. Pulmonary vein isolation was performed in all patients. Additional LA ablation was performed in 16 patients; 4 had CTI ablation. There was 1 major complication of cardiac tamponade requiring pericardiocentesis.
Conclusions: CU is an intuitive mapping system that together with FS catheters and ICE imaging facilitates catheter manipulation during LA ablation, allowing very low fluoroscopy exposure, even during training of EP fellows.
Author Disclosures: M. Murphy: None. A. Mealor: None. W. Camnitz: None. A. Darby: Consultant/Advisory Board; Modest; Biosense Webster, Inc. R. Malhotra: Other Research Support; Modest; Boeringer Ingleheim. Speakers Bureau; Modest; Medtronic, Inc. K. Bilchick: None. P. Mason: Honoraria; Modest; Medtronic, Inc. Consultant/Advisory Board; Modest; Medtronic, Inc. J. Ferguson: Honoraria; Modest; Biosense Webster, Inc, st. Jude Medical. Consultant/Advisory Board; Modest; Biosense Webster, Inc, St. Jude Medical. M. Mangrum: Research Grant; Modest; Hansen Medical, Boston Scientific Corp, St. Jude Medical, Cardiofocus, Inc. Consultant/Advisory Board; Modest; St. Jude Medical, Hansen Medical, Phillips.
- © 2016 by American Heart Association, Inc.