Zero‐fluoroscopy catheter ablation for atrial fibrillation: a transitional period experience

BACKGROUND: Radiofrequency catheter ablation for atrial fibrillation (AF) without using fluoroscopy has been getting popular. In this study, we reported the transition period experience of the zero‐fluoroscopy procedure by an experienced operator and shared our zero‐fluoroscopy protocol. METHOD: A total of consecutive 30 AF ablation cases attempted to be treated without fluoroscopy were investigated. Ten serial cases were grouped as fluoroscopy‐guided period, and period 1‐3 in chronological order. All zero‐fluoroscopy attempted cases were assisted with an intracardiac echocardiography device with a three‐dimensional electroanatomical system. RESULTS: Complete zero‐fluoroscopy procedure was achieved at the 6th case during the transitional period. During the first period, the total procedure time slightly increased in, but afterward, procedure time was continuously decreased, and it became significantly shorter in the third period than the previous fluoroscopy‐guided period. Any additional use of fluoroscopy during the transitional period was mainly for transseptal puncture and diagnostic catheter placement into the coronary sinus. Pulmonary vein isolation was achieved in all patients, and there was one case of hemodynamically insignificant moderate amount pericardial effusion. CONCLUSION: For an experienced operator, complete zero‐fluoroscopy AF ablation might be achieved safely and feasibly within 5‐10 cases. Fluoroscopy equipment backup might be useful during the learning period for beginners in the zero‐fluoroscopy procedure.