title: Catheter ablation of atrial fibrillation without fluoroscopy using intracardiac echocardiography and electroanatomic mapping.
abstract: BACKGROUND
  Catheter ablation of atrial fibrillation is currently guided by x-ray fluoroscopy. The associated radiation risk to patients and medical staff may be significant. We report an atrial fibrillation ablation technique using intracardiac echocardiography (ICE) and electroanatomic mapping without fluoroscopy.
  
  
  RESULTS
  Twenty-one patients with atrial fibrillation (age, 42 to 73 years; 14 male; 14 paroxysmal, 7 persistent; body mass index, 26 to 38) underwent ablation. A decapolar catheter was advanced through the left subclavian vein until stable coronary sinus electrograms appeared on all electrodes. Two 9F sheaths were advanced transfemorally over a guide wire to the right atrium. A rotational ICE catheter was advanced through a deflectable sheath. Double transseptal puncture was performed with ICE guidance and facilitated by electrocautery. A 3D MRI left atrial image was registered to the ostia of the pulmonary veins using ICE. Catheter ablation was performed using ICE and electroanatomic mapping navigation. In 19 cases, no fluoroscopy was used and the staff did not wear protective lead. In 2 cases, 2 to 16 minutes of fluoroscopy was used to assist transseptal puncture. Median procedure time was 208 (188 to 221) minutes; coronary sinus cannulation took 5 (2 to 26) minutes; double transseptal took 26 (17 to 40) minutes; left atrial ablation time was 103 (90 to 127) minutes. All patients underwent circumferential pulmonary vein ablation and 8 patients underwent additional left atrial ablation. There were no procedure-related complications.
  
  
  CONCLUSIONS
  Catheter ablation of atrial fibrillation without fluoroscopy is feasible and merits further attention. This technique may be especially helpful in preventing x-ray exposure in children, pregnant women, and obese patients undergoing left atrial ablation.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22908, USA. jdf7h@virginia.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Ferguson
authors.forename: Adam
authors.initials: A
authors.lastname: Helms
authors.forename: J Michael
authors.initials: JM
authors.lastname: Mangrum
authors.forename: Srijoy
authors.initials: S
authors.lastname: Mahapatra
authors.forename: Pamela
authors.initials: P
authors.lastname: Mason
authors.forename: Ken
authors.initials: K
authors.lastname: Bilchick
authors.forename: George
authors.initials: G
authors.lastname: McDaniel
authors.forename: David
authors.initials: D
authors.lastname: Wiggins
authors.forename: John P
authors.initials: JP
authors.lastname: DiMarco
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional