Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned

Table 1 Techniques and technologies for catheter ablation of atrial fibrillation in the four patient cohorts considered in our center

	1st cohort	2nd cohort	3rd cohort	4th cohort
No. of patients	30	30	30	30
Procedure technique	Double TSP-C Circular mapping catheter Imaging integration (CT scan)	Unchanged	Unchanged	Unchanged
NF technology	2nd generation NF 3-DS (CARTO XP)	3rd generation NF 3-DS (CARTO3)	Unchanged	CARTO3 + contact force sensing
Technology feature for NF use	NF visualization of the mapping/ablation catheter	NF visualization of all inserted catheter	Unchanged	Monitoring of the electrode/tissue contact added
NF 3-DS optimization	Yes	No	Yes (Table 2)	Yes (Table 2)
Timing	Last 30 cases with CARTO XP	First 30 cases with CARTO3	After 12 mo	After 12 mo

3-DS: Three dimensional system; CT: Computed tomography; NF: Non-fluoroscopic; TSP-C: Transseptal catheterization.

Table 2 Features of the third generation non-fluoroscopic system CARTO 3 useful to minimize fluoroscopy during an electrophysiology procedure

Feature	Function
Imaging integration with pre-acquired CT or MRI image	Allows high resolution visualization of the LA and PVs; once registered in the system, the mapping/ablation catheter can be navigated with minimal use of fluoroscopy
Display in stable mode of the icon of the mapping/ ablation catheter	Allows stable visualization of the mapping/ablation catheter on the system, similar to the one visualized on fluoroscopy
Colors on the distal part of the mapping/ablation catheter	Indicate the direction of the deflection of the distal part of the catheter
Catheter projection	Estimates the distance from the catheter tip to the surface of the electroanatomic map or to the surface of the CT/MRI image
Contact force sensing	Measures in grams the contact between the catheter tip and the tissue; used to avoid excessive contact during catheter manipulation and to optimize contact during ablation
Real time display of the circular mapping catheter	Allows real time visualization of the circular mapping catheter during positioning into the PVs
Highlight of the circular mapping catheter electrodes	Identify the position of the electrodes of the circular mapping catheter; used to identify the site of a conducting gap during circumferential PV ablation
Catheter snapshot	Shows a memorized position of a catheter (e.g., circular mapping catheter); used to precisely re-navigated a previous catheter positioning

CT: Computed tomography; LA: Left atrium; MRI: Magnetic resonance imaging; PV: Pulmonary vein.