A standardized stepwise zero-fluoroscopy approach with transesophageal echocardiography guidance for atrial fibrillation ablation

摘要

Abstract Purpose There is growing interest in performing fluoroless radiofrequency ablation (RFA) for atrial fibrillation (AF) due to the increasing awareness of risk associated with radiation exposure of patients and professional staff. The present study aimed to evaluate the feasibility, safety, and efficacy of a stepwise transesophageal echocardiography (TEE)–guided zero-fluoroscopy approach (ZFA) for RFA.Methods Consecutive patients (n?=?111) referred for AF-ablation were prospectively enrolled with intention to RFA with ZFA. Procedural outcomes were compared with historical controls (HCs) after 1:1 propensity score matching. ZFA success was considered when no X-ray was utilized to perform the whole procedure.Results ZFA success was achieved in 80 (72) procedures. BMI?>?35?kg/m2 resulted in the only independent predictor of ZFA failure (OR?=?6.10, 95 CI 1.15–46.49, p?=?0.04). In comparison to HCs, a significant reduction in radiation exposure was observed in the ZFA group: fluoroscopy time (3 vs. 63?s, p?