Study: Electroanatomic mapping an effective and patient-friendly alternative to fluoroscopy

Researchers have successfully shown that utilization of electroanatomic mapping technology is just as effective and practical as traditional fluoroscopy in cardiac ablation procedures, according to results of a study published online in the Journal of Innovations in Cardiac Rhythm Management.

Electrophysiologic procedures such as radiofrequency ablation of cardiac arrhythmias have typically required fluoroscopy to ensure treatment effectiveness, exposing the patient to necessary but also potentially harmful levels of radiation.

But with the rise of new treatment technologies like electroanatomic mapping, the need for fluoroscopy—and the inherent risks it poses to patients—could soon become a thing of the past, said lead author Sandeep Gautam, MD, of the Missouri University School of Medicine, and colleagues.

“There have been some reports and case series of both simple and complex arrhythmias in adults being performed without fluoroscopy, mostly using a combination of three-dimensional [electroanatomic mapping] techniques, intracardiac echocardiogram, and remote magnetic navigation systems” they wrote. “However, use of fluoroless ablation remains extremely sporadic, most likely owing to concerns about procedural safety, efficacy, and efficiency.”

For the study, Gautam and his team compared 20 consecutive patients who underwent fluoroless ablation for atrial flutter with a prior series of 20 patients with standard flutter ablation, using CARTO 3 mapping software to position diagnostic and ablation catheters in the first group.

Their results showed both techniques were effective at successfully ablating atrial flutter and achieving bidirectional CTI block, though the group undergoing fluoroscopy received a mean duration and dosage of 6.3±3.3 min and 138±119 mGy, respectively. No difference was found in procedure duration, ablation duration, time to ablation start or time from catheter insertion to optimal placement between the two methods.

“Fluoroless ablation for right atrial CTI-dependent flutter is safe and practical, with obvious advantages of avoidance of radiation exposure to patients and staff,” the researchers concluded. “Further studies are warranted applying these principles to other arrhythmia substrates.”