Atrial fibrillation ablation is a procedure performed to attempt to cure afib. It is traditionally performed using fluoroscopy (X-Ray) to guide, and exposure to radiation is a concern. In order to minimize and sometimes completely avoid the use of radiation during the procedure newer techniques using the mapping systems have been developed. This presentation shows some of the techniques I use to minimize fluoroscopy during ablation. This was presented at a course for electrophysiology fellows.

1. Jose Osorio, MD

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Elective Procedure
Potentially serious or even fatal
complications
SAFE PROCEDURE - #1 Priority
 Specially if you are just out of a fellowship

3. 
It has to be safe for you as well

9. Afib ablation
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100% fluoroscopic
navigation
Mapping system
used for “tagging”
No ultrasound

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3 months out of fellowship
 Exceeded the radiation exposure at the VA
 Making changes was not optional
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Changes
 Rad-Pad
 Better use of shields/Rad Tech
 Carto

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There are many ways
How do other EPs do?
 Visit other sites
 Literature
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Afib ablation during fellowship
 You should not stop there
 Constant improvement

12. 
CS catheter placement
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“Trust” the 3D map
 You really don’t need the fluoroscopic images
 Know the anatomy  really well
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Intracardiac Echo

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FAM
VISITAG™ MODULE
Curve Visualization
UNIVU™ MODULE
Intracardiac Echo
Cartographer

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65 yo man
Typical flutter ablation 2 years ago
Paroxysmal Afib shortly after
No CAD
Failed Bystolic and diltiazem
Very symptomatic

15. Follow guidelines:
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Try drug therapy first
- Informed Consent / Patient education
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The more informed the better
No unrealistic expectations

16. UNIVU™ MODULE

21. “FAM”of PVs

22. “FAM”of PVs

31. 
Analyze PACs
Entrance and Exit Block

32. Local PV capture with exit block

33. Tags of Isolation Points

42. 
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Patient selection
Rely heavily on Carto
Single Transeptal
Endpoints

43. 
Safe Procedure
 Patient
 You and the Staff
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3D mapping tools
 Fluoroscopy reduction
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EP Fellowship
 The beginning of your journey as an EP