How to Achieve Near Zero Fluoroscopy During Radiofrequency Ablation of Atrial Fibrillation: A Strategy Used at Two Centers

Radiofrequency ablation for atrial fibrillation is currently the most effective rhythm control strategy. These procedures, although safe, pose a risk for potential exposure to radiation and can be time consuming. Radiation exposure during ablation can increase the risk of serious complications in both patients as well as physicians. The overall procedure time also increases with use of fluoroscopy. Advances in mapping technology, such as electroanatomic mapping, use of contact force technology, intracardiac echocardiography and use of versatile sheaths and catheters has vastly enhanced our ability to both shorten the procedure duration and minimize or even eliminate radiation exposure. Use of near zero fluoroscopy technique is increasingly gaining acceptance in electrophysiology centers. At this point, there is no uniform technique and various centers use individual techniques based on their expertise and availability of various tools. There is need for a uniform technique that is workflow friendly and widely accepted. There is a learning curve associated with this technique and efforts should be made to incorporate zero fluoroscopic technique for ablation as an essential part of electrophysiology training programs. In this paper, we present the strategy being practiced at two centers, that involves a series of steps, to either decrease or eliminate the use of fluoroscopy during atrial fibrillation ablation.