Impact of a Novel Catheter Tracking System on Radiation Exposure during the Procedural Phases of Atrial Fibrillation and Flutter Ablation

Background Fluoroscopic guidance is used to position catheters during cardiac ablation. We evaluated the impact of a novel nonfluoroscopic sensor-guided electromagnetic navigation system (MG) on radiation exposureduring catheter ablationof atrial fibrillation(AF) or atrial flutter(AFL). Methods A total of 134 consecutive patients referred for ablationof AF (n = 44) or AFL (n = 90) ablationwere prospectively enrolled. In one group the MG system was used for nonfluoroscopic catheter positioning, whereas in the conventional group standard fluoroscopywas utilized. Fluoroscopytimes were assessed for each stage of procedure and total radiation exposurewas quantified. Results Patient characteristics were similar between the groups. The procedural end point was achieved in all. Median (interquartile range [IQR]) fluoroscopytimes were 12.5 minutes (7.6, 17.4) MG group versus 21.5 minutes (15.3, 23.0) conventional group (P < 0.0001) for AF ablation, and 0.8 minutes (0.4, 2.5) MG group versus 9.9 minutes (5.1, 22.5) conventional group (P < 0.0001) for AFL ablation. Median (IQR) total radiation exposure(μGy·m2) was 1,107 (906, 2,033) MG group versus 2,835 (1,688, 3,855) conventional group (P = 0.0001) for AF ablation, and 161 (65, 537) MG group versus 1,651 (796, 4,569) conventional group (P < 0.0001) for AFL ablation. No difference in total procedural time was seen. Conclusions The use of a novel nonfluoroscopic catheter tracking system is associated with a significant reduction in radiation exposureduring AF and AFL ablation(61% and 90% reduction, respectively). In the era of heightened awareness of the importance of radiation reduction, this system represents a safe and efficient tool to decrease radiation exposureduring electrophysiological ablationprocedures.