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A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation

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Abstract

Purpose

There is growing interest in performing fluoroless radiofrequency ablation (RFA) for atrial fibrillation (AF) due to the increasing awareness of risk associated with radiation exposure of patients and professional staff. The present study aimed to evaluate the feasibility, safety, and efficacy of a stepwise transesophageal echocardiography (TEE)–guided zero-fluoroscopy approach (ZFA) for RFA.

Methods

Consecutive patients (n = 111) referred for AF-ablation were prospectively enrolled with intention to RFA with ZFA. Procedural outcomes were compared with historical controls (HCs) after 1:1 propensity score matching. ZFA success was considered when no X-ray was utilized to perform the whole procedure.

Results

ZFA success was achieved in 80 (72%) procedures. BMI > 35 kg/m2 resulted in the only independent predictor of ZFA failure (OR = 6.10, 95% CI 1.15–46.49, p = 0.04). In comparison to HCs, a significant reduction in radiation exposure was observed in the ZFA group: fluoroscopy time (3 vs. 63 s, p < 0.001), total emitted fluoroscopy dose (0.2 vs. 6.0 mGy, p < 0.001), dose area product (0.04 vs. 1.4 Gy*cm2, p < 0.001), and effective dose (0.8 vs. 27.2 mSv*100, p < 0.001). Complete pulmonary vein isolation was achieved in all procedures. No difference was observed between the groups in in-hospital complication rate (0.9% vs. 1.8%, p = 0.99).

Conclusions

This is the largest study proving procedural feasibility, safety, and efficacy of TEE-guided AF-ablation with a complete or near-complete avoidance of radiological exposure, without using intracardiac echocardiography.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Authors and Affiliations

  1. Teknon Medical Centre, Heart Institute, Calle Villana 12, 08022, Barcelona, Spain

    Giulio Falasconi, Diego Penela, David Soto-Iglesias, Beatriz Jáuregui, Alfredo Chauca, Rodolfo San Antonio, Augusto Ordoñez, Cheryl Teres, Jose Miguel Carreño, Claudia Scherer, Daniel Viveros, Marina Huguet, Jose Torres, Pedro Vergara, Giuliana Maldonado, Alejandro Panaro & Antonio Berruezo

  2. Vita-Salute University, San Raffaele, Milan, Italy

    Giulio Falasconi

  3. Pompeu Fabra University, Barcelona, Spain

    Oscar Cámara

Authors
  1. Giulio Falasconi
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  2. Diego Penela
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Giulio Falasconi, Diego Penela, and David Soto-Iglesias. The first draft of the manuscript was written by Giulio Falasconi, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Antonio Berruezo.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Ethics Committee.

Conflict of interest

Dr. Berruezo is a stockholder of ADAS 3D Medical. Dr. Soto-Iglesias is an employee of Biosense Webster. The other authors declare no competing interests.

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Falasconi, G., Penela, D., Soto-Iglesias, D. et al. A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation. J Interv Card Electrophysiol 64, 629–639 (2022). https://doi.org/10.1007/s10840-021-01086-9

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  • DOI: https://doi.org/10.1007/s10840-021-01086-9

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