Combining conventional technique with fluoroscopy integration module in accessory pathway ablation

• Published in: Journal of cardiovascular electrophysiology Vol. 34; no. 12; pp. 2573 - 2580
• Main Authors: Ozcan, Emin Evren, Turan, Oğuzhan Ekrem, Yilancioğlu, Reşit Yiğit, Inevi, Umut, Akdemir, Barış
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2023
• Subjects: Ablation; Accessory Atrioventricular Bundle - diagnostic imaging; Accessory Atrioventricular Bundle - surgery; accessory pathway ablation; cardiac electrophysiology; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; Fluoroscopy; Fluoroscopy - methods; fluoroscopy integration module; Humans; Integration; Mapping; Radiation; Radiation Dosage; radiation exposure; radiofrequency catheter ablation; Success; supraventricular tachycardia; Time Factors; Treatment Outcome; cardiac electrophysiology; fluoroscopy integration module; radiofrequency catheter ablation; supraventricular tachycardia; radiation exposure; accessory pathway ablation
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16110

Introduction Accessory pathway (AP) ablation is a straightforward approach with high success rates, but the fluoroscopy time (FT) is significantly longer in conventional technique. Electroanatomical mapping systems (EMS), reduce the FT, but anatomical and activation mapping may prolong the procedure time (PT). The fluoroscopy integration module (FIM) uses prerecorded fluoroscopy images and allows ablation similar to conventional technique without creating an anatomical map. In this study, we investigated the effects of combining the FIM with traditional technique on PT, success, and radiation exposure. Methods A total of 131 patients who had undergone AP ablation were included in our study. In 37 patients, right and left anterior oblique (RAO‐LAO) images were acquired after catheter placement and integrated with the FIM. The ablation procedure was then similar to the conventional technique, but without the use of fluoroscopy. For the purpose of acceleration, anatomical and activation maps have not been created. Contact‐force catheters were not used. 94 patients underwent conventional ablation using fluoroscopy only. Results FIM into AP ablation procedures led to a significant reduction in radiation exposure, lowering FT from 7.4 to 2.8 min (p < .001) and dose‐area product from 12.47 to 5.8 μGym² (p < .001). While the FIM group experienced a reasonable longer PT (69 vs. 50 min p < .001). FIM reduces FT regardless of operator experience and location of APs Conclusion Combining FIM integration with conventional AP ablation offers reduced radiation exposure without compromising success rates and complication. Fluoroscopy integration module (FIM) facilitates 3D guided accessory pathway ablation without anatomical reconstruction. Combining conventional technique with FIM provide significantly reduced radiation exposure with reasonable procedure time.  FIM, fluoroscopy integration module; 3D, 3 dimensional.