For decades, cardiac electrophysiologists have used fluoroscopy to help guide them during ablation procedures. From obtaining access to the heart through veins and arteries in the groin, to catheter positioning, mapping, and ablation, fluoroscopy has always been considered "indispensible". However, radiation exposure is a well-recognized occupational hazard, and the detrimental effects of radiation range from cataracts to cancers. Compelling new studies indicate that performing ablations with minimal, or no, fluoroscopy— with assistance of newer technologies like ultrasound and 3-D mapping—is not only possible, but feasible, during most ablation procedures. This approach is safer for patients, physicians, and procedural staff without adding significantly to procedure duration in most cases.
Aditya Saini, MD, who recently completed an advanced clinical cardiac electrophysiology (EP) fellowship at Virginia Commonwealth University, and now is a member of the EP staff at MedStar Union Memorial Hospital, says there is growing focus during training at most academic programs on skills and techniques for minimizing fluoroscopy and radiation exposure during ablations.
“At MedStar Union Memorial, we try to minimize fluoroscopy by using ultrasound guidance to access veins or arteries, then 3-D mapping and intra-cardiac ultrasound to guide catheter placement and reach specific areas of the heart,” he says. “Because these technologies have gotten so much more sophisticated, fluoroscopy isn’t required at all for many ablation procedures, and the remainder can be performed with minimal fluoroscopy, resulting in significantly lower radiation exposure. While there are still going to be times you need this tool, it’s no longer ‘indispensible.’ More often than not, it is just a habit we need to unlearn as physicians. Routine use of minimal-to-zero fluoroscopy in ablation techniques is here to stay, and is the near future of electrophysiology.”