651 zero fluoroscopy cardiac ablation: a novel workflow for atrial fibrillation

Abstract Background and Rationale A fluoroscopy-based approach to an electrophysiological procedure is widely validated and has been recognized as the gold standard for a long time. The use of fluoroscopy exposes both the healthcare staff and the patient to a non-negligible dose of radiation. To minimize the risks associated with the use of fluoroscopy, it would be reasonable to perform ablation procedures with zero fluoroscopy. This approach is widely used in simple ablation procedures, but not in complex procedures. In atrial fibrillation (AF) ablation procedures, fluoroscopy remains the main technology used, particularly to guide the transseptal puncture. Main results and Implications We present a workflow to perform a complete zero-fluoroscopy ablation for AF ablation procedures using a 3D electro-anatomical mapping system, intracardiac echocardiography and a novel steerable guiding sheath that can be visualized on the mapping system. We present two AF ablation procedures, one performed on a patient with paroxysmal AF (Fig.1) and one with persistent AF (Fig. 2, Fig 3) during which we applied this novel workflow, achieving a successful pulmonary vein isolation without complications and complete zero-fluoroscopy exposure.