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Original Articles

Catheter Ablation of Atrial Fibrillation Without Fluoroscopy Using Intracardiac Echocardiography and Electroanatomic Mapping

John D. Ferguson, MBChB, MD; Adam Helms, MD; J. Michael Mangrum, MD; Srijoy Mahapatra, MD; Pamela Mason, MD; Ken Bilchick, MD; George McDaniel, MD; David Wiggins, BS and John P. DiMarco, MD, PhD

From the Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Va.

Correspondence to John D. Ferguson, MD, Division of Cardiovascular Medicine, Department of Medicine, Lee St, University of Virginia, PO Box 800158, Charlottesville, VA 22908. E-mail jdf7h{at}virginia.edu

Received April 9, 2009; accepted July 20, 2009.

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.

Methods and 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.

Key Words: atrial fibrillation • catheter ablation • fluoroscopy • radiation risk

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CLINICAL PERSPECTIVE

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