A Multicenter, Multinational Exploration of the Contribution of Discrete Intraprocedural Segments to Overall Fluoroscopy Use During Atrial Fibrillation Ablation

초록

Introduction | Objectives: Reduction of radiation exposure in atrial fibrillation (AF) ablation procedures has become an area of increasing focus in recent years. While total fluoroscopy time is a commonly reported metric, the specific intraprocedural steps that drive overall use are not well studied, and thus may provide insights into where there are opportunities to further reduce the harmful effects of ionizing radiation. The objective is to examine trends in fluoroscopy use during atrial fibrillation (AF) ablation, including individual procedural steps that drive overall fluoroscopy use during ablation of AF. Methods:Acute procedure data from 649 AF cases was prospectively collected from 75 centers in nine countries. Procedure workflow, use of technology, and fluoroscopy use were left to physician discretion. Fluoroscopy times for the entire procedure, including intraprocedural steps driving overall use, were recorded in all cases. Results: Of the 649 cases,de novo paroxysmal AF (PAF) was the most common indication (336 cases; 52%) (Table 1). Across all cases, an average total fluoroscopy time of 14.9±17.6 minutes was observed, with use during ablation accounting for 41.6% of the total fluoroscopy time (6.2±10.0 min). Following ablation, segments accounting for fluoroscopy usage were procedure close (2.9±10.2 min), mapping (2.3±3.7 min), transseptal puncture (1.9±3.6 min), and initial catheter placement (1.8±3.5 min). Usage patterns across various subindications are shown in Table 1. Conclusions: Usage patterns were relatively consistent across AF subindications; LsPersAF appeared to be an outlier although that may have been driven by small sample size. Ablation had the greatest impact on overall fluoroscopy use, accounting for nearly half of the total fluoroscopy time. Future efforts to minimize radiation exposure may be well‐served by focusing on reducing use during ablation, potentially by embracing alternative imaging modalities such as 3D mapping technologies and intracardiac echocardiography (ICE). Further analysis is needed to compare and quantify the impact that technology use and workflow preferences may have on reducing fluoroscopy use in AF cases, notably during ablation.