Jose Osorio, Gustavo Morales, Anil Rajendra, Tina D Hunter
{"title":"Clinical Outcomes of Ablation for Persistent Atrial Fibrillation with Zero or Minimal Fluoroscopy.","authors":"Jose Osorio, Gustavo Morales, Anil Rajendra, Tina D Hunter","doi":"10.2147/POR.S526839","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Recent developments in electroanatomical mapping (EAM), intracardiac echocardiography, and sheath technology have allowed for a pronounced reduction or complete elimination of fluoroscopy during catheter ablation of atrial fibrillation (AF). This real-world study evaluates the procedural efficiency, clinical effectiveness, and safety of a zero- to minimal-fluoroscopy workflow in an exclusively persistent AF (PsAF) population.</p><p><strong>Methods: </strong>Data on consecutive PsAF catheter ablations performed with a fluoroscopy minimization workflow by three operators at a single high-volume center in the United States between January 2017 and December 2018 were collected and analyzed. All procedures were performed with EAM guidance and a contact force ablation catheter. Patients were followed for a year post-ablation for safety, arrhythmia recurrences, and reablation. Outcomes of interest included procedural efficiency measures, single-procedure success (freedom from reablation at any time or recurrence after 90-day blanking), and procedure-related complications.</p><p><strong>Results: </strong>The study included 406 PsAF patients (age 67.8 ± 10.1 years, 65.3% male, and CHA<sub>2</sub>DS<sub>2</sub>-VASc score 2.9 ± 1.5). Over 85% of ablations were performed without fluoroscopy, and ablations utilizing fluoroscopy averaged only 0.6 ± 1.5 minutes for a mean fluoroscopy time of 0.1 ± 0.6 minutes overall. Mean procedure time was 89.5 minutes, with 96.3% of the procedures including ablation beyond the pulmonary veins. Single-procedure success was 73.6% (95% confidence interval: [68.7%, 77.8%]). Eight patients (2.0%) experienced a procedure-related complication.</p><p><strong>Conclusion: </strong>Minimal-fluoroscopy ablation was performed safely and without compromise to procedural efficiency or clinical effectiveness in a real-world population of PsAF patients, despite more extensive ablation than a typical paroxysmal AF population.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"16 ","pages":"179-187"},"PeriodicalIF":2.7000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476173/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pragmatic and Observational Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/POR.S526839","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Recent developments in electroanatomical mapping (EAM), intracardiac echocardiography, and sheath technology have allowed for a pronounced reduction or complete elimination of fluoroscopy during catheter ablation of atrial fibrillation (AF). This real-world study evaluates the procedural efficiency, clinical effectiveness, and safety of a zero- to minimal-fluoroscopy workflow in an exclusively persistent AF (PsAF) population.
Methods: Data on consecutive PsAF catheter ablations performed with a fluoroscopy minimization workflow by three operators at a single high-volume center in the United States between January 2017 and December 2018 were collected and analyzed. All procedures were performed with EAM guidance and a contact force ablation catheter. Patients were followed for a year post-ablation for safety, arrhythmia recurrences, and reablation. Outcomes of interest included procedural efficiency measures, single-procedure success (freedom from reablation at any time or recurrence after 90-day blanking), and procedure-related complications.
Results: The study included 406 PsAF patients (age 67.8 ± 10.1 years, 65.3% male, and CHA2DS2-VASc score 2.9 ± 1.5). Over 85% of ablations were performed without fluoroscopy, and ablations utilizing fluoroscopy averaged only 0.6 ± 1.5 minutes for a mean fluoroscopy time of 0.1 ± 0.6 minutes overall. Mean procedure time was 89.5 minutes, with 96.3% of the procedures including ablation beyond the pulmonary veins. Single-procedure success was 73.6% (95% confidence interval: [68.7%, 77.8%]). Eight patients (2.0%) experienced a procedure-related complication.
Conclusion: Minimal-fluoroscopy ablation was performed safely and without compromise to procedural efficiency or clinical effectiveness in a real-world population of PsAF patients, despite more extensive ablation than a typical paroxysmal AF population.
期刊介绍：
Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.
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