Electroanatomic mapping and transoesophageal echocardiography for near zero fluoroscopy during complex left atrial ablation

Hariharan Raju*, John Whitaker, Carly Taylor, Matthew Wright

*Corresponding author for this work

Research output: Contribution to journalArticle

13 Citations (Scopus)


Background: We evaluated Carto 3, transoesophageal echocardiography (TOE) and contact force (CF) sensing catheter in atrial fibrillation (AF) ablation. Methods: Unselected consecutive ablations performed under general anaesthesia (GA) were studied with modified protocol (cases, n=11) and compared to retrospective consecutive controls (n=10). Patent foramen ovale (PFO) or single transseptal puncture enabled left atrial (LA) access; ablation strategy was stepwise approach. Modified protocol utilised right atrial (RA) electrograms, CF and TOE to localise SmartTouch and create RA and CS electroanatomic map (EAM) without fluoroscopy. Transseptal puncture was performed with fluoroscopy in absence of PFO. Fluoroless pulmonary vein and LA EAM was created using TOE to locate circular-mapping catheter. Results: Mean age of cases was 57±11 years with 64% male compared with 60±11 (70% male) for controls. Patent foramen ovale was identified in four cases (36%) and two controls (20%). No early complications occurred. Shorter fluoroscopy time (median 36 vs 390 seconds; p=0.038) and trend to lower radiation dose (median 17 vs 165 cGym2; p=0.053) was seen in cases, with no increase in total procedure time (p=0.438). Conclusions: General anaesthesia, TOE and CF mapping catheters facilitate minimised fluoroscopy for catheter ablation of LA arrhythmias. Zero fluoroscopy is possible in a majority of cases with PFO.

Original languageEnglish
Pages (from-to)652-660
Number of pages9
JournalHeart, Lung and Circulation
Issue number7
Publication statusPublished - 1 Jul 2016
Externally publishedYes


  • Atrial fibrillation
  • Catheter ablation
  • Fluoroscopy
  • Foramen ovale
  • Patent
  • Radiation dosage

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