Fluoroscopy Reduction Techniques for Catheter Ablation of Cardiac Arrhythmias

Catheter ablation has become a widely used approach to treating various cardiac arrhythmias. Traditionally, catheter ablation procedures are guided by fluoroscopic imaging to help understand catheter position during mapping. The potentially significant exposure to radiation to the patient, physician, and staff increases risks of radiation exposure-related disease. Also, the protective lead garments worn increases risks of orthopedic injury. Current advanced electroanatomic mapping and intracardiac echocardiography technology have allowed the development of endocardial catheter ablation techniques without the use of fluoroscopy safely and effectively.  

A host of expert and experienced authors present a practical overview of the rationale and methodology for a low- or zero-fluoro environment in the electrophysiology lab with the critical goal of significantly reducing radiation exposure to the patient, physician, and staff.

This practical guide:

• Covers the entire spectrum of commonly (and less commonly) performed ablation procedures via endocardial approach.

• Discusses general principles that are applicable across ICE and EAM platforms.

• Will assist the electrophysiologist and their team to safely and effectively work toward the significant reduction in fluoroscopy utilization while also likely improving procedural safety, i.e., fewer complications, after the adoption of these techniques.

• Includes a library of 50 videos, with 9 extended films (108 minutes) by Dr. Razminia detailing step-by-step procedures and techniques.

“An important text for all electrophysiologists, replete with crucial advice on the optimal use of nonfluoroscopic tools for better ablation safety and efficacy.”
-  Amin Al-Ahmad, MD

“I congratulate Drs. Razminia and Zei on a wonderful contribution to the electrophysiology literature that will foster continued advances in the field that will improve safety and outcomes. This book is a wonderful source of guidance toward that goal.”
-  William G. Stevenson, MD

Table of Contents

Section 1: Basis of Imaging in the Electrophysiology Lab

1 Radiation Safety in the Electrophysiology Lab

           Kristen Breedlove, John Clark

2 How to Use Intracardiac Echocardiography to Reduce Fluoroscopy

            Cameron Willoughby

3 How to Use Electroanatomic Mapping to Reduce Fluoroscopy

            Kristen Breedlove, John Clark

4 How to Use Technologies such as MediGuide and CARTOUNIVU to Reduce Fluoroscopy During Catheter Ablation

            Martin Borlich, Philipp Sommer

5 How to Obtain Central Vascular Access Using Real-time Ultrasound

            Carola Gianni, Carlos Monreal, Zachary J. Rosenblatt, Jason T. Engel, Clayton Robison, Rodney P. Horton, Andrea Natale, Amin Al-Ahmad

6 How to Perform Transseptal Puncture Without Fluoroscopy

            José Mauricio Sánchez

7 How to Maintain Safety With a Reduced Fluoroscopy Approach

            José Osorio, Gustavo X. Morales

8 How to Monitor Esophageal Temperature Without Fluoroscopy

            Oliver D’Silva, Hany Demo, Theodore Wang, Mansour Razminia

Section 2: Ablation of Supraventricular Tachycardia

9 How to Ablate Atrioventricular Nodal Reentrant Tachycardia Using No Fluoroscopy

            Nicholas Von Bergen, Ian H. Law

10 How to Ablate Accessory Pathways Using No Fluoroscopy

            Raman L. Mitra

11 How to Ablate Typical Atrial Flutter Using No Fluoroscopy

            Saurabh Shah

12 How to Ablate Atrial Tachycardia and Atypical Flutter Using No Fluoroscopy

            Dan Alyesh, Sri Sundaram

Section 3: Ablation of Atrial Fibrillation

13 How to Perform Radiofrequency Ablation of  Atrial Fibrillation Using No Fluoroscopy

            Robin Singh, Paul C. Zei

14 How to Perform Cryo-Balloon Ablation of Atrial Fibrillation Using No Fluoroscopy

            Hany Demo, Oliver D’Silva, Mansour Razminia

Section 4: Ablation of Ventricular Arrhythmias

15 How to Perform Premature Ventricular Complex Ablation Originating From the Right Ventricle and Right Ventricular Outflow Tract Using No Fluoroscopy

            Christopher I. Jones, Roderick Tung

16 How to Perform Ablation in the Coronary Cusps Using No Fluoroscopy

            José Mauricio Sánchez

17 How to Perform Ablation of Premature Ventricular Complexes Originating from the Left Ventricular Outflow Tract Using No Fluoroscopy

            Nicholas J. Costa, Jim W. Cheung

18 How to Perform Papillary Muscle Premature Ventricular Complex Ablation Using No Fluoroscopy

            Oliver D'Silva, Hany Demo, Theodore Wang, Mansour Razminia

19 How to Perform Ablation of Ischemic and Non-Ischemic Ventricular Tachycardia Using No Fluoroscopy

            Amit Thosani

Section 5: Special Populations

20 How to perform Catheter Ablation During Pregnancy: Special Considerations

            John D. Ferguson

21 How to Perform Catheter Ablation in the Pediatric Population Using No Fluoroscopy

            Nicholas Von Bergen, Ian H. Law