Published Online
on September 12, 2009

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Original Article

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

John D. Ferguson¹; Adam Helms; J. Michael Mangrum; Srijoy Mahapatra; Pamela K. Mason; Kenneth C. Bilchick; George McDaniel; David Wiggins and John P. DiMarco

University of Virginia, Charlottesville, VA

^* Corresponding author; email: jdf7h{at}virginia.edu

Background—Catheter ablation of atrial fibrillation (AF) is currently guided by X-ray fluoroscopy. The associated radiation risk to patients and medical staff may be significant. We report an AF ablation technique using intracardiac echocardiography (ICE) and electroanatomical mapping (EM) without fluoroscopy.

Methods and Results—Twenty-one patients with AF (age 42-73 years, 14 male, 14 paroxysmal, 7 persistent, BMI 26-38) underwent ablation. A decapolar catheter was advanced via 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 EM navigation. In 19 cases, no fluoroscopy was used and the staff did not wear protective lead. In 2 cases, 2-16 mins of fluoroscopy was used to assist transseptal puncture. Median procedure time was 208(188-221)mins; CS cannulation took 5(2-26) mins, double transseptal took 26(17-40) mins; left atrial ablation time 103(90-127) mins. All patients underwent circumferential PV ablation and 8 patients underwent additional left atrial ablation. There were no procedure related complications.

Conclusions—Catheter ablation of AF without any 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: catheter ablation • atrial fibrillation • fluoroscopy • radiation risk