Our Summary

This research paper discusses a method of performing a heart procedure, called catheter ablation, without using fluoroscopy - a type of medical imaging that uses X-rays. This procedure is used to treat irregular heart rhythms (arrhythmias) that originate from the top of the left ventricle (the left ventricular summit), which is a complex area of the heart.

Traditionally, fluoroscopy has been used to guide catheter ablation, but it comes with risks such as exposure to radiation and physical injuries from the heavy protective gear that doctors must wear. Moreover, some techniques that have been suggested to improve the procedure, such as pericardial mapping and ablation and the use of intracoronary wires, can extend the time fluoroscopy is used, increasing these risks.

The researchers propose that it is possible to perform catheter ablation without fluoroscopy, using currently available technology. They suggest that this method is just as safe and effective as traditional techniques. Crucially, to perform this procedure without fluoroscopy, doctors need to be very familiar with two other techniques: intracardiac echocardiography (a type of ultrasound used to see inside the heart) and electroanatomic mapping (a technique used to locate the source of the arrhythmia). The paper describes their approach to performing this fluoroscopy-free procedure.

FAQs

  1. What risks are associated with prolonged use of fluoroscopy during catheter ablation of arrhythmias?
  2. How are fluoroless CA procedures for ventricular arrhythmias performed?
  3. How do the safety and efficacy outcomes of fluoroless CA procedures compare with conventional techniques?

Doctor’s Tip

A doctor might tell a patient undergoing cardiac ablation to ask about the possibility of a fluoroless procedure, which can reduce exposure to ionizing radiation and the risk of orthopedic injuries. It is important for the patient to be fully acquainted with intracardiac echocardiography (ICE) imaging and electroanatomic mapping (EAM) for a successful fluoroless procedure.

Suitable For

Patients who are typically recommended for cardiac ablation include those with:

  • Atrial fibrillation
  • Supraventricular tachycardia
  • Ventricular tachycardia
  • Wolff-Parkinson-White syndrome
  • Atrial flutter

These patients may have symptoms such as palpitations, dizziness, chest pain, shortness of breath, or fatigue, and may not have responded well to medication or other treatments. Additionally, patients with structural heart disease or a history of cardiac arrest may also be candidates for cardiac ablation.

Timeline

  • Before cardiac ablation:
  1. Patient undergoes a thorough evaluation by a cardiologist to determine the need for cardiac ablation.
  2. Patient may undergo various tests such as an electrocardiogram (ECG), echocardiogram, and possibly a cardiac MRI to assess the heart’s structure and function.
  3. Patient may be prescribed medications to control their symptoms and arrhythmias leading up to the procedure.
  4. Patient will be instructed on fasting and medication guidelines prior to the procedure.
  • During cardiac ablation:
  1. Patient is typically admitted to the hospital on the day of the procedure.
  2. Patient is placed under sedation or general anesthesia.
  3. Cardiac catheters are inserted through a vein in the groin or neck and guided to the heart.
  4. Electroanatomic mapping is used to identify the location of the abnormal heart tissue causing the arrhythmia.
  5. Radiofrequency energy is delivered through the catheter to destroy or scar the abnormal tissue.
  6. The procedure can take several hours to complete depending on the complexity of the arrhythmia.
  • After cardiac ablation:
  1. Patient is monitored closely in a recovery area for a few hours post-procedure.
  2. Patient may experience some chest discomfort, fatigue, or mild palpitations in the days following the procedure.
  3. Patient may need to stay overnight in the hospital for observation.
  4. Patient will be instructed on post-procedure care, including medication management and activity restrictions.
  5. Follow-up appointments will be scheduled to monitor the success of the procedure and the patient’s recovery.

What to Ask Your Doctor

  1. What is the purpose of cardiac ablation in my specific case?
  2. What are the potential risks and complications associated with cardiac ablation?
  3. How experienced are you in performing cardiac ablation procedures?
  4. Will I need to undergo any specific tests or preparations before the procedure?
  5. How long will the procedure take, and will I need to stay in the hospital afterwards?
  6. What is the success rate of cardiac ablation for my condition?
  7. Will I need to take any medications or make lifestyle changes after the procedure?
  8. How soon can I expect to feel the effects of the cardiac ablation?
  9. Are there any alternative treatment options to consider?
  10. How often will I need follow-up appointments after the procedure?

Reference

Authors: Romero J, Diaz JC, Gamero M, Alviz I, Lorente M, Gabr M, Toquica CC, Krishnan S, Velasco A, Lin A, Natale A, Zou F, Di Biase L. Journal: Card Electrophysiol Clin. 2023 Mar;15(1):75-83. doi: 10.1016/j.ccep.2022.10.002. PMID: 36774139