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Reducing Ionizing Radiation Associated with Atrial Fibrillation Ablation

While radiation exposure with cardiac interventional procedures is an emerging concern, patients undergoing radiofrequency ablation (RFA) for atrial fibrillation (AF) still routinely undergo pre- and post-ablation computed tomography (CT) scans for 1) definition of left atrial and pulmonary vein anatomy, 2) creation of a surrogate geometry, and 3) assessment for complications such as pulmonary vein (PV) stenosis. In an effort to decrease ionizing radiation associated with atrial fibrillation ablation, an ultrasound-guided surrogate geometry approach is proposed as an alternative to routine CT imaging. Ten patients underwent AF ablation using intracardiac ultrasound for the creation of a surrogate left atrial geometry (CartoSound, Biosense Webster, CA); and ten control-cases who had conventional CT-guided imaging (CartoMerge, Biosense Webster, CA) were matched for age, gender, and type of catheter ablation. Sources of radiation included 1) intraprocedural fluoroscopy (CartoSound: 151 43 mGray*cm^2, CartoMerge: 174 130 mGray*cm^2; p=0.6) and 2) CT ionizing radiation (CartoSound: 0 mSv, CartoMerge 9.4 2.3 mSv/CT scan.) When comparing clinical success rates after a trial of previously ineffective anti-arrhythmic drugs, ultrasound-guided AF ablation was non-inferior to a CT-guided approach, and obviated the need for CT imaging, therefore reducing doses of ionizing radiation by nearly 20 mSv per AF catheter ablation.

Credits: Nisha L. Bhatia, MD; Arshad Jahangir, MD; William Pavlicek, PhD; Luis R.P. Scott, MD; Gregory T. Altemose, MD; Komandoor Srivathsan, MD

Biosense Webster
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Introduction to AFib
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