Outcomes and Safety of Fluoroless Catheter Ablation for Atrial Fibrillation

Abstract Background Intracardiac echocardiography and 3D mapping systems allow catheter ablation for atrial fibrillation (AF) to be conducted without fluoroscopy; however, safety and effectiveness of fluoroless AF ablation are not well defined. Methods We examined consecutive radiofrequency AF catheter ablations at a large academic teaching hospital from November 2017 to July 2019. Outcomes for fluoroscopy-guided (N=176) and fluoroless (N=147) ablations were compared. Cases were designated as fluoroless at the outset of the procedure. Results Mean age was 59.5±10 years, 66.9% were male, 71.8% had paroxysmal AF and the mean CHA2DS2-VASc score was 1.7±1.4. There were no differences in patient baseline characteristics. In the fluoroless group, minimal fluoroscopy was used in 17 patients (median 3 seconds, interquartile range 1.2 – 4.8). Mean procedure time, fluoroscopy time and radiation dose (±SD) were greater in the fluoroscopy group compared to the fluoroless group (194 ±56 vs. 176 ±46 minutes, p=0.0021; 10.7 ±6.6 vs. 0.008 ±0.03 minutes, p 2 , p Conclusions Fluoroless radiofrequency AF ablation had similar effectiveness and safety compared to conventional fluoroscopy-guided AF ablation.