title: Fluoroscopy-Free Pulmonary Vein Isolation in Patients with Atrial Fibrillation and a Patent Foramen Ovale Using Solely an Electroanatomic Mapping System.
abstract: BACKGROUND
  The advent of electroanatomical mapping (EAM) systems for pulmonary vein isolation (PVI) has dramatically decreased radiation exposure. However, the need for some fluoroscopy remains for obtaining left atrial (LA) access. The aim was to test the feasibility of fluoroscopy-free PVI in patients with atrial fibrillation (AF) and a patent foramen ovale (PFO) guided solely by an EAM system.
  
  
  METHODS
  Consecutive patients with AF undergoing PVI and documented PFO were studied. An EAM-guided approach without fluoroscopy and ultrasound was used. After completing the map of the right atrium, the superior vena cava and the coronary sinus, a catheter pull-down to the PFO was performed allowing LA access. The map of the LA and subsequent PVI was also performed without fluoroscopy.
  
  
  RESULTS
  30 patients [age 61±12 years, 73% male, ejection fraction 0.64 (0.53-0.65), LA size in parasternal long axis 38±7 mm] undergoing PVI were included. The time required for right atrial mapping including transseptal crossing was 9±4 minutes. Total procedure time was 127±37 minutes. Fluoroscopy-free PVI was feasible in 26/30 (87%) patients. In four patients, fluoroscopy was needed to access (n = 3) or to re-access (n = 1) the LA. In these four patients, total fluoroscopy time was 5±3 min and the DAP was 14.9±13.4 Gy*cm2. Single-procedure success rate was 80% (24/30) after a median follow-up of 12 months.
  
  
  CONCLUSIONS
  In patients with a documented PFO, completely fluoroscopy-free PVI is feasible in the vast majority of cases.
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Aline
authors.initials: A
authors.lastname: Mühl
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: University Hospital Centre ''Sisters of mercy'', Zagreb, Croatia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Pavlović
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Arnheid
authors.initials: A
authors.lastname: Kessel-Schaefer
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Beat A
authors.initials: BA
authors.lastname: Kaufmann
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Schaer
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D054092:Foramen Ovale, Patent / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
references.citation: Circulation. 2001 Jul 3;104(1):58-62
references.pmid: 11435338
references.citation: Europace. 2015 Nov;17(11):1694-9
references.pmid: 25995391
references.citation: Mayo Clin Proc. 1999 Sep;74(9):862-9
references.pmid: 10488786
references.citation: Circulation. 2004 Nov 9;110(19):3003-10
references.pmid: 15505084
references.citation: Heart Rhythm. 2009 Mar;6(3):439-44
references.pmid: 19201659
references.citation: Europace. 2012 Apr;14(4):528-606
references.pmid: 22389422
references.citation: Am J Cardiol. 2012 Apr 15;109(8):1179-86
references.pmid: 22245414
references.citation: Europace. 2012 Oct;14(10):1385-413
references.pmid: 22923145
references.citation: J Am Coll Cardiol. 1999 Nov 15;34(6):1823-30
references.pmid: 10577576
references.citation: J Interv Card Electrophysiol. 2013 Jan;36(1):47-54; discussion 54
references.pmid: 23090778
references.citation: J Cardiovasc Electrophysiol. 2014 May;25(5):479-84
references.pmid: 24384060
references.citation: J Cardiovasc Electrophysiol. 2014 Jun;25(6):638-44
references.pmid: 24611978
references.citation: Pacing Clin Electrophysiol. 2014 Aug;37(8):1029-37
references.pmid: 24628051
references.citation: J Interv Card Electrophysiol. 2014 Dec;41(3):261-6
references.pmid: 25403549
references.citation: Mayo Clin Proc. 1984 Jan;59(1):17-20
references.pmid: 6694427