title: Effective reduction of fluoroscopy duration by using an advanced electroanatomic-mapping system and a standardized procedural protocol for ablation of atrial fibrillation: 'the unleaded study'.
abstract: OBJECTIVE
  It is recommended to keep exposure to ionizing radiation as low as reasonably achievable. The aim of this study was to determine whether fluoroscopy-free mapping and ablation using a standardized procedural protocol is feasible in patients undergoing pulmonary vein isolation (PVI).
  
  
  RESULTS
  Sixty consecutive patients were analysed: Thirty consecutive patients undergoing PVI using Carto3 were treated using a standardized procedural fluoroscopy protocol with X-ray being disabled after transseptal puncture (Group 1) and compared with a set of previous 30 consecutive patients undergoing PVI without a specific recommendation regarding the use of fluoroscopy (Group 2). The main outcome measures were the feasibility of fluoroscopy-free mapping and ablation, total fluoroscopy time, total dose area product (DAP), and procedure time. Sixty patients (age 60 ± 10 years, 73% male, ejection fraction 0.55 ± 0.09, left atrium 42 ± 8 mm) were included. In Group 1, total fluoroscopy time was 4.2 (2.6-5.6) min and mapping and ablation during PVI without using fluoroscopy was feasible in 29 of 30 patients (97%). In Group 2, total fluoroscopy time was 9.3 (6.4-13.9) min (P < 0.001). Total DAP was 13.2 (6.2-22.2) Gy*cm(2) in Group 1 compared with 17.5 (11.7-29.7) Gy*cm(2) in Group 2 (P = 0.036). Total procedure time did not differ between Groups 1 (133 ± 37 min) and 2 (134 ± 37 min, P = 0.884).
  
  
  CONCLUSIONS
  Performing mapping and ablation guided by an electroanatomic-mapping system during PVI without using fluoroscopy after transseptal puncture using a standardized procedural protocol is feasible in almost all patients and is associated with markedly decreased total fluoroscopy duration and DAP.
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Pavlovic
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Aline
authors.initials: A
authors.lastname: Mühl
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Schaer
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Research Institute Basel, Basel, Switzerland michael.kuehne@usb.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards; D022062:Electrophysiologic Techniques, Cardiac / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000592:standards; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011677:Punctures; D011829:Radiation Dosage; D016896:Treatment Outcome
keywords: Atrial fibrillation; Fluoroscopy; Mapping systems; Pulmonary vein isolation; Radiation