Nonfluoroscopic catheter visualization in atrial fibrillation ablation: experience from 375 consecutive procedures

A technological platform (MediGuide) has been recently introduced for nonfluoroscopic catheter tracking. No data on the safety of this technology are yet available in a large cohort of patients.

Data from a prospective ablation registry were analyzed. All patients undergoing atrial fibrillation ablation procedures supported by nonfluoroscopic catheter visualization technology were included. Patient characteristics and procedural data and complications within the first 3 months were recorded. Between May 2012 and February 2014, a total of 375 patients underwent atrial fibrillation ablation using nonfluoroscopic catheter visualization technology. The patients were predominantly men (68%); the majority were ablated for the first time (71%); left atrium was 43±6 mm; and left ventricular function was normal (59±9%). The median ablation procedure time was 135 (113-170) minutes, median fluoroscopy time 2.8 (1.5-4.4) minutes, and median radiation dose 789 (470-1466) cGy*cm(2). Regression analysis demonstrated a significant decrease of fluoroscopy time, dose, and procedure time. To confirm the result and show overall changes, the initial 50 cases (group 1) to the last 50 cases (group 2) of the series were compared: fluoroscopy time decreased from 6.0 (4.1-10.3) minutes in group 1 to 1.1 (0.7-1.5) minutes in group 2 and radiation dose from 2363 (1413-3475) to 490 (230-654) cGy*cm(2), respectively. Ten patients (2.7%) experienced complications: 5 cardiac tamponades (1.4%), 4 pseudoaneurysms (1.1%), and 1 stroke (0.3%).

Atrial fibrillation ablation using the nonfluoroscopic catheter visualization technology is safe with a rate of complications of 2.7%. Procedure time (135 minutes) is not prolonged. A dramatic reduction in fluoroscopy time and dose was achieved.