title: Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study.
abstract: OBJECTIVE
  We explored whether the use of a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping (F-EAM) system could result in a reduction of overall fluoroscopy time and radiation doses during the whole procedure of atrial fibrillation (AF) ablation.
  
  
  METHODS
  Eighty patients (44 men (55%); mean age 63 ± 10 years) who underwent catheter ablation due to paroxysmal AF were recruited consecutively in the present study. Patients were randomized (1:1) into 2 arms for AF ablation: one using a conventional 3-dimensional electroanatomical mapping (EAM) system and the other using the F-EAM system.
  
  
  RESULTS
  Fluoroscopy time (10:42 [interquartile range {IQR} 8:45-12:46] minutes:seconds vs 1:45 [IQR 1:05-2:22] minutes:seconds; P < .001) and radiation doses (2440 [IQR 1593-3091] cGy·cm(2) vs 652 [IQR 326-1489] cGy·cm(2); P < .001) in the EAM group were significantly greater than those in the F-EAM group. The majority of reduction of radiation exposure was achieved after transseptal puncture, which was near-zero fluoroscopic exposure. In total, approximately 84% of fluoroscopy time and 73% of radiation doses have been reduced during the AF ablation procedure using the F-EAM system compared to using the conventional EAM system. However, procedure time did not differ significantly (1:39 [IQR 1:18-2:10] hours:minutes vs 1:37 [IQR 1:17-1:50] hours:minutes; P = .362). During follow-up (5.9 ± 1.3 months), 61 patients (76.3%) had no recurrence of atrial arrhythmias. The recurrence rate between the 2 groups did not differ.
  
  
  CONCLUSIONS
  AF catheter ablation using the F-EAM system was safe and resulted in a significant reduction of radiation exposure to patients and staff without complicating the workflow of the procedure. A near-zero fluoroscopic catheter ablation procedure could be performed without compromising acute/mid-term efficacy and safety.
authors.affiliation: Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany; Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany. Electronic address: dr.huoyan@googlemail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huo
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Marian
authors.initials: M
authors.lastname: Christoph
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Forkmann
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pohl
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Mayer
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Jozef
authors.initials: J
authors.lastname: Salmas
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Sitzy
authors.affiliation: Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Wunderlich
authors.affiliation: Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany; Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.affiliation: Steinbeis Research Institute 'Electrophysiology and Cardiac Devices', Dresden, Germany; Department of Electrophysiology, Heart Center Dresden, Dresden University of Technology, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D017115:Catheter Ablation / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D015203:Reproducibility of Results; D016037:Single-Blind Method; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013614:Tachycardia, Paroxysmal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrial fibrillation ablation; Fluoroscopy time; Paroxysmal atrial fibrillation; Radiation exposure; radiation doses; voltage map guided atrial fibrillation ablation