The standard procedure for treating an irregular heartbeat is done so with a visual technique that inflicts high doses of radiation to both the person undergoing surgery and the doctors involved in the procedure. From Weill Cornell Medicine, researchers offer an alternative solution to reduce the radiation exposure to almost zero, without changing the effectiveness of the overall procedure.
Atrial fibrillation (AF), a condition characterized by an arrhythmic heart rate due to the “misfiring of electrical impulses,” is usually treated with a minimally invasive procedure called catheter ablation. The procedure itself isn’t relatively dangerous, but surgeons often use an imaging technique called fluoroscopy alongside catheter ablation to increase their visibility of the heart. During catheter ablation, wires are inserted into blood vessels and guided through the body to the heart, where they release either radiofrequency energy or freezing temperatures to resolve the electrical impulse problem.
Fluoroscopy helps surgeons visualize the heart with a continuous X-ray beam, which has dangerous repercussions on everyone involved in the procedure due to increasing amounts of radiation.
"The amount of fluoroscopy received by a patient during a routine AF ablation procedure is estimated to be the equivalent of the dose of radiation a patient would receive with 830 X-rays," explained lead author Dr. Bruce Lerman. "In our hands, the vast majority of AF patients do not require fluoroscopy, resulting in no radiation exposure to the patient or the electrophysiologist performing the procedure."
Lerman’s alternative involves using high-frequency sound waves, intracardiac echocardiography (ICE), instead of fluoroscopy to visualize the heart and complete the procedure. Additional application of computerized three-dimensional mapping systems and using pre-procedural cardiac imaging will also help to make fluoroscopy unnecessary.
"Although the concept of fluoroless catheter ablation was introduced several years ago, it has yet to gain wide adoption, mostly because many electrophysiologists were trained to rely on X-ray imaging and are reluctant to trust ICE," explained co-author Dr. Jim Cheung. "This concern can be remedied with experience. For some, the learning curve can be steep, but generally, the skill set can be readily acquired. By thoughtfully modifying the way the procedure is performed, we can significantly reduce the radiation risk in the process."
Cheung and Lerman are going ahead with their fluoroless catheter ablation approach, teaching their colleagues the ins and outs of successfully completing the procedure. "The most critical requisite for performing fluoroless catheter ablation of AF is a willingness to relinquish an old habit," Lerman said. "Doing so will have a tremendous advantage for both patients and healthcare professionals."
The present study was published in the journal Heart Rhythm.
Source: Weill Cornell Medicine
