Pulmonary vein isolation (PVI) is the cornerstone of the interventional treatment of atrial fibrillation (AF). Traditionally, during these procedures the catheters are guided by fluoroscopy, which poses a risk to the patient and staff by ionizing radiation. Our aim was to describe our experience in the implementation of an intracardiac echocardiography (ICE) guided zero fluoroscopic (ZF) ablation approach to our routine clinical practice. We developed a simplified ICE guided technique to perform ablation procedures for AF, with the aid of a 3D electroanatomical mapping system. The workflow was implemented in two phases: (1) the Introductory phase, where the first 16 ZF PVIs were compared with 16 cases performed with fluoroscopy and (2) the Extension phase, where 71 consecutive patients (including repeat procedures) with ZF approach were included. Standard PVI (and redoPVI) procedures were performed, data on feasibility of the ZF approach, complications, acute and 1-year success rates were collected. In the Introductory phase, 94% of the procedures could be performed with complete ZF with a median procedure time of 77.5 (73.5–83) minutes. In one case fluoroscopy was used to guide the ICE catheter to the atrium. There was no difference in the complication, acute and 1-year success rates, compared with fluoroscopy guided procedures. In the Extension phase, 97% of the procedures could be completed with complete ZF. In one case fluoroscopy was used to guide the transseptal puncture and in another to position the ICE catheter. Acute success of PVI was achieved in all cases, 64.4% patients were arrhythmia free at 1-year. Acute major complications were observed in 4 cases, all of these occurred in the redo PVI group and consisted of 2 tamponades, 1 transient ischemic attack and 1 pseudoaneurysm at the puncture site. The procedures were carried out by all members of the electrophysiology unit in the Extension phase, including less experienced operators and electrophysiology fellows (3 physicians) under the supervision of the senior electrophysiologist. Consequently, procedure times became longer [90 (75–105) vs 77.5 (73.5–85) min, p = 0.014]. According to our results, a ZF workflow of AF ablations can be successfully implemented into the routine practice of an electrophysiology laboratory, without compromising safety and effectivity.

中文翻译：

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使用简化的心内超声心动图引导方法实施零透视工作流程，用于心房颤动的导管消融，包括重复程序

肺静脉隔离（PVI）是房颤（AF）介入治疗的基石。传统上，在这些手术过程中，导管由透视引导，这会给患者和工作人员带来电离辐射的风险。我们的目的是描述我们在常规临床实践中实施心内超声心动图 (ICE) 引导的零透视 (ZF) 消融方法的经验。我们开发了一种简化的 ICE 引导技术，以在 3D 电解剖映射系统的帮助下执行 AF 消融程序。工作流程分两个阶段实施：(1) 介绍阶段，将前 16 个 ZF PVI 与 16 个使用透视的病例进行比较；(2) 扩展阶段，其中 71 名连续患者（包括重复手术）采用 ZF 方法包括。执行标准 PVI（和 redoPVI）程序，收集有关 ZF 方法的可行性、并发症、急性和 1 年成功率的数据。在介绍阶段，94% 的手术可以使用完整的 ZF 进行，平均手术时间为 77.5 (73.5–83) 分钟。在一个案例中，透视被用来将 ICE 导管引导到心房。与透视引导程序相比，并发症、急性成功率和 1 年成功率没有差异。在扩展阶段，97% 的程序可以用完整的采埃孚完成。在一个案例中，透视被用于引导经中隔穿刺，在另一个案例中用于定位 ICE 导管。所有病例均实现了 PVI 的快速成功，64.4% 的患者在 1 年时无心律失常。4例出现急性严重并发症，所有这些都发生在重做 PVI 组中，包括 2 次填塞、1 次短暂性脑缺血发作和 1 次穿刺部位的假性动脉瘤。这些程序由电生理学部门的所有成员在扩展阶段执行，包括经验不足的操作员和电生理学研究员（3 名医生），并在高级电生理学家的监督下进行。因此，手术时间变得更长 [90 (75-105) 比 77.5 (73.5-85) 分钟，p = 0.014]。根据我们的结果，AF 消融的 ZF 工作流程可以成功地实施到电生理实验室的常规实践中，而不会影响安全性和有效性。这些程序由电生理学部门的所有成员在扩展阶段执行，包括经验不足的操作员和电生理学研究员（3 名医生），并在高级电生理学家的监督下进行。因此，手术时间变得更长 [90 (75-105) 比 77.5 (73.5-85) 分钟，p = 0.014]。根据我们的结果，AF 消融的 ZF 工作流程可以成功地实施到电生理实验室的常规实践中，而不会影响安全性和有效性。这些程序由电生理学部门的所有成员在扩展阶段执行，包括经验不足的操作员和电生理学研究员（3 名医生），并在高级电生理学家的监督下进行。因此，手术时间变得更长 [90 (75-105) 比 77.5 (73.5-85) 分钟，p = 0.014]。根据我们的结果，AF 消融的 ZF 工作流程可以成功地实施到电生理实验室的常规实践中，而不会影响安全性和有效性。