Combined use of electro-anatomic mapping system and intracardiac echocardiography to achieve zero-fluoroscopy catheter ablation for treatment of paroxysmal atrial fibrillation: a single centre experience

  • Matevž JanEmail author
  • David Žižek
  • Dimitrij Kuhelj
  • Nikola Lakič
  • Tine Prolič Kalinšek
  • Jernej Štublar
  • Luka Klemen
  • Andrej Pernat
  • Bor Antolič
Original Paper


Fluoroscopy is the principal imaging method for catheter ablation (CA) of atrial fibrillation (AF). However, radiation exposure carries potential health risk to patients and operators alike. Our aim was to study safety and efficacy of zero-fluoroscopy CA of paroxysmal AF with a combined use of electroanatomic mapping system (EAM) and intracardiac echocardiography (ICE). In addition, impact of ICE/EAM automatic integration system and contact force (CF) sensing technology on procedural times were assessed. We included 144 consecutive patients (69% males, age 60 ± 10 years, BMI 29 ± 4,6) referred for CA of symptomatic paroxysmal AF. All procedures were performed only with EAM system and ICE. No fluoroscopy was used. The acute procedural success of complete pulmonary vein isolation was achieved in all patients (100%) and adverse events were detected in eight patients (5.6%). In 53 (37%) patients the use of ICE/EAM automatic integration system shortened procedural times compared to those performed without it (148 ± 35 vs. 187 ± 44 min, p < 0.05). Similarly, 89 (60%) procedures where CF sensing catheter was used were shorter compared to those performed without it (163 ± 41 vs. 188 ± 46 min, p < 0.05). Zero-fluoroscopy approach for treatment of paroxysmal AF seems feasible, safe, and acutely effective. Additional reduction of procedural times could be achieved with the use of ICE/EAM automatic integration system and CF sensing technology.


Zero-fluoroscopy Catheter ablation Paroxysmal atrial fibrillation Electro-anatomic mapping system Intracardiac echocardiography 


Compliance with ethical standards

Conflict of interest

Matevž Jan and Bor Antolič have received honoraria from Biosense Webster. These honoraria were unrelated to the present study.

Financial support/funding


Ethical approval

The study complies with the Declaration of Helsinki. The study protocol was approved by The National Medical Ethics Committee.

Informed consent

All patients gave written informed consent before entering the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Cardiovascular Surgery DepartmentUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Cardiology DepartmentUniversity Medical Centre LjubljanaLjubljanaSlovenia
  3. 3.Clinical Institute for RadiologyUniversity Medical Centre LjubljanaLjubljanaSlovenia

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