A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation.

Falasconi, G ; Penela, D ; Soto-Iglesias, D ; Jáuregui, B ; Chauca, A ; Antonio, RS ; Ordoñez, A ; Teres, C ; Carreño, JM ; Scherer, C ; Viveros, D ; Huguet, M ; Torres, J ; Vergara, P ; Maldonado, G ; Panaro, A ; Cámara, O ; Berruezo, A

Resumen: Purpose
There is growing interest in performing fluoroless radiofrequency ablation (RFA) for atrial fibrillation (AF) due to the increasing awareness of risk associated with radiation exposure of patients and professional staff. The present study aimed to evaluate the feasibility, safety, and efficacy of a stepwise transesophageal echocardiography (TEE)–guided zero-fluoroscopy approach (ZFA) for RFA.

Methods
Consecutive patients (n = 111) referred for AF-ablation were prospectively enrolled with intention to RFA with ZFA. Procedural outcomes were compared with historical controls (HCs) after 1:1 propensity score matching. ZFA success was considered when no X-ray was utilized to perform the whole procedure.

Results
ZFA success was achieved in 80 (72%) procedures. BMI > 35 kg/m2 resulted in the only independent predictor of ZFA failure (OR = 6.10, 95% CI 1.15–46.49, p = 0.04). In comparison to HCs, a significant reduction in radiation exposure was observed in the ZFA group: fluoroscopy time (3 vs. 63 s, p < 0.001), total emitted fluoroscopy dose (0.2 vs. 6.0 mGy, p < 0.001), dose area product (0.04 vs. 1.4 Gy*cm2, p < 0.001), and effective dose (0.8 vs. 27.2 mSv*100, p < 0.001). Complete pulmonary vein isolation was achieved in all procedures. No difference was observed between the groups in in-hospital complication rate (0.9% vs. 1.8%, p = 0.99).

Conclusions
This is the largest study proving procedural feasibility, safety, and efficacy of TEE-guided AF-ablation with a complete or near-complete avoidance of radiological exposure, without using intracardiac echocardiography.

Idioma: Inglés

DOI: 10.1007/s10840-021-01086-9

Año: 2021

Publicado en: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY 64 (2021), 629 - 639
ISSN: 1383-875X

Factor impacto JCR: 1.759 (2021)

Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 122 / 143 = 0.853 (2021) - Q4 - T3

Factor impacto CITESCORE: 3.0 - Medicine (Q2)

Factor impacto SCIMAGO: 0.68 - Medicine (miscellaneous) (Q2) - Cardiology and Cardiovascular Medicine (Q2)

Tipo y forma: Artículo (PostPrint)