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Fluoroscopy Exposure (fluoroscopy + exposure)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Reduced Fluoroscopy During Atrial Fibrillation Ablation: Benefits of Robotic Guided Navigation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010
DANIEL STEVEN M.D.
Reduced Fluoroscopy in PVI Using RN.,Background: Recently, a nonmagnetic robotic navigation system (RN, Hansen-SenseiÔ) has been introduced for remote catheter manipulation. Objective: To investigate the influence of RN combined with intuitive 3-dimensional mapping on the fluoroscopy exposure to operator and patient during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial. Methods: Sixty patients were randomly assigned to undergo PVI either using a RN guided (group 1; n = 30, 20 male, 62 ± 7.7 years) or conventional ablation approach (group 2; n = 30, 14 male, 61 ± 7.6 years). A 3-dimensional mapping system (NavXÔ) was used in both groups. Results: Electrical disconnection of the ipsilateral pulmonary veins (PVs) was achieved in all patients. Use of RN significantly lowered the overall fluoroscopy time (9 ± 3.4 vs 22 ± 6.5 minutes; P < 0.001) and reduced the operator's fluoroscopy exposure (7 ± 2.1 vs 22 ± 6.5 minutes; P < 0.001). The difference in fluoroscopy duration between both groups was most pronounced during the ablation part of the procedure (3 ± 2.4 vs 17 ± 6.3 minutes; P < 0.001). The overall procedure duration tended to be prolonged using RN without reaching statistical significance (156 ± 44.4 vs 134 ± 12 minutes, P = 0.099). No difference regarding outcome was found during a midterm follow-up of 6 months (AF freedom group 1 = 73% vs 77% in group 2 [P = 0.345]). Conclusion: The use of RN for PVI seems to be effective and significantly reduces overall fluoroscopy time and operator's fluoroscopy exposure without affecting mid-term outcome after 6-month follow-up. (J Cardiovasc Electrophysiol, Vol. 21, pp. 6,12, January 2010) [source]

Randomized Comparison Between Open Irrigation Technology and Intracardiac-Echo-Guided Energy Delivery for Pulmonary Vein Antrum Isolation: Procedural Parameters, Outcomes, and the Effect on Esophageal Injury

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007
NASSIR F. MARROUCHE M.D.
Introduction: We performed a prospective study to compare efficacy and safety of both open irrigation tip (OIT) technology with intracardiac echo (ICE)-guided energy delivery in patients presenting for PVAI. Methods and Results: Fifty-three patients presenting for PVAI were randomized to ablation using an OIT catheter (Group 1, 26 patients; temperature and power were set at 50° and 50 W, respectively, with a saline pump flow rate of 30 mL/min) or radiofrequency (RF) energy delivery under ICE guidance (Group 2, 27 patients; energy was titrated based on microbubbles formation). The mean procedure time and fluoroscopy exposure were lower in Group 1 (164 ± 42 min and 7,560 ± 2,298 ,Graym2 vs 204 ± 47 min and 12,240 ± 4,356 ,Graym2; P = 0.005 and 0.008, respectively). Moreover, the durations of RF lesions applied per PV antrum was lower in Group 1 compared with Group 2 (5.1 ± 2.2 min vs 9.2 ± 3.2 min, P = 0.03, respectively). Within 24 hours after PVAI in 35.7% (all erythema) of Group 1 and 57.1% (21.4% erythema and 35.7% necrosis) of Group 2, patients' esophageal wall changes were documented. After 14 ± 2 months of follow up, recurrences were documented in 19.2% of Group 1 and 22.2% of Group 2 patients. Conclusion: Although both OIT and ICE-guided energy delivery possess a similar effect in treating AF, OIT seems to be superior in terms of achieving isolation and shortening fluoroscopy exposure. Moreover, a lower incidence of esophageal wall injury was observed utilizing OIT for PVAI. [source]

Cryoablation of Accessory Pathways in Children

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2007
VOLKAN TUZCU M.D.
Background: Cryoablation is utilized for septal tachycardia substrates due its safety. Considering the recent studies which reveal coronary artery stenosis related to radiofrequency ablation (RFA) in children, cryoablation may offer advantages for nonseptal accessory pathways (APs) as well. The aim of this study was to investigate the efficacy and safety of cryoablation of APs in children. Methods: A total of 39 patients (median age = 9.3 years, range 4.8 to 17.2 years) underwent cryoablation of APs. A three-dimensional, surface electrode-based navigation system (EnSite NavXÔ, St.Jude Medical Inc., St. Paul, MN, USA) is used to decrease the fluoroscopy exposure. Results: A total of 45 APs were identified. Of these APs, 23 were septal (anteroseptal, midseptal, posteroseptal) and 22 were nonseptal. Acute success rate with cryoablation was 73%. RFA was used when cryoablation failed and overall acute success rate was 84%. To assess for the effect of institutional experience, the initial 23 APs were compared to the recent 22 APs and acute success rate revealed significant improvement (57% vs. 91%). Recurrence rate was 24% during a median follow-up of 282 days. Conclusion: Cryoablation of APs is safe and yields to high acute success rates in children. It can potentially be used as the first ablation option for all APs in children. However, recurrence rate is higher compared to the RFA and there is a need for prospective comparative studies. [source]

Importance of Anterograde Visualization of the Coronary Venous Network by Selective Left Coronary Angiography Prior To Resynchronization

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2007
NICOLAS DELARCHE M.D.
Background: Understanding of coronary anatomy is essential to the advancement of cardiac resynchronization therapy (CRT) techniques. We determined whether the difficulties associated with catheterization of the coronary sinus (CS) and its lateral branches could be overcome by a preliminary angiographical study of the coronary venous system carried out during a pre-operative coronary angiography with examination of venous return. Methods and Results: All patients were scheduled for an exploratory angiography procedure and indicated for CRT. Group A patients were implanted with a CRT device after a right arterial angiographical procedure while group B patients had a selective left angiogram including examination of venous return. Data analyzed in group B were: position of CS ostium, number and distribution of lateral branches, and ability to preselect a marginal vein suitable for catheterization. Subsequent device implantation was guided by these parameters. A total of 96 and 89 patients were included in groups A and B, respectively. Implantation success rates were not different (98% and 100%, respectively), but CS catheterization time was reduced in group B (6 minutes vs 4 minutes; P < 10,6) as well as total time required to position the left ventricular lead (25 minutes vs 15 minutes; P < 10,6), fluoroscopy exposure (7 minutes vs 5 minutes; P < 10,6), and volume of contrast medium required (45 mL vs 15 mL; P < 10,6). Conclusion: A coronary angiographical study, including examination of the coronary venous return prior to implantation of a CRT device, can simplify the device implant and allows patient-specific preselection of appropriate tools for the procedure. [source]