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Zero-Fluoroscopy Atrial Fibrillation Ablation: Initial experience in a single-center cohort
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 12 - AVANÇOS EM ABLAÇÃO: TÉCNICAS, FERRAMENTAS E RESULTADOS
Speaker:
Miguel Sobral Domingues
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Miguel Sobral Domingues; Joana Certo Pereira; Francisco Moscoso Costa; Daniel Gomes; Gustavo Rodrigues; Daniel Matos; João Carmo; Pedro Galvão Santos; Pedro Carmo; Francisco Morgado; Diogo Cavaco; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction:</span></strong><span style="font-family:"Calibri",sans-serif"> Zero-fluoroscopy (ZF) atrial fibrillation (AF) ablation is an innovative technique, combining intracardiac echocardiography (ICE) and mapping systems to avoid radiation exposure for both patients and physicians.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Objectives:</span></strong><span style="font-family:"Calibri",sans-serif"> This study aimed to describe a single-center experience with ZF AF ablation, focusing on procedural techniques, immediate success rates, and safety outcomes.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong><span style="font-family:"Calibri",sans-serif"> Retrospective data were collected for consecutive ZF ablation procedures performed between October 2023 and December 2024. A descriptive and statistical analysis was conducted for procedural features, immediate efficacy, and safety outcomes.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Results:</span></strong><span style="font-family:"Calibri",sans-serif"> During the study period, 44 ZF ablation procedures were performed, including 22 AF ablation cases (60% male; mean age: 59 years). Paroxysmal AF accounted for 80% of cases and persistent AF for 20%. This represented 2% of the total AF ablation cohort (n=758) during the same period. All patients underwent right atrial mapping and coronary sinus catheterization using a <em>Decanav</em> catheter. Transseptal puncture and left atrial mapping were guided by intracardiac echocardiography (ICE) with <em>CARTO 3</em> (n=20) and <em>Ensite NavX</em> (n=2) mapping systems. <em>Cartosound FAM</em> IA based module was employed for anatomical mapping in 50% of cases (n=11). Complete pulmonary vein isolation (PVI) was achieved in all patients, with additional linear ablation performed in 4 cases. Radiofrequency was used in 14 patients (64%) and pulse field ablation (PFA) in 8 patients (36%). Among PFA cases, <em>VARIPULSE</em> ablation catheter was used in 5 patients and <em>FARAPULSE</em> in 3 patients. Sinus rhythm was restored in 85% of cases, with 15% requiring electrical cardioversion. For cases with PVI-only, median left-sided catheter dwelling time and total procedure time were comparable to the global AF ablation cohort (46 min [IQR 38–58] vs 55 min [IQR 44–72] and 78 min [IQR 73–115] vs 79 min [IQR 63–106]; both, p>0.05). No complications, including cardiac tamponade, stroke, or major vascular hemorrhage, were reported.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusions:</span></strong><span style="font-family:"Calibri",sans-serif"> Our findings demonstrate the feasibility of ZF AF ablation, achieving radiation-free procedures with high safety and efficacy. Complete pulmonary vein isolation was successful in all cases, with no significant increase in procedure duration compared to standard fluoroscopy-guided ablation. This technique offers a promising and safer alternative for the treatment of AF, for both patients and physicians.</span></span></span></p>
Slides
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