Study supports low and zero fluoroscopy workflow as safe, effective alternative to conventional catheter ablation

The results support the use of workflows to reduce radiation exposure during catheter ablation for the treatment of paroxysmal atrial fibrillation (AFib) while maintaining safety, efficacy, and long-term patient outcomes comparable to traditional procedures.

“Cardiac ablation procedures for the treatment of AFib usually require fluoroscopy to guide intracardiac catheters, which can result in considerable radiation exposure for patients, operators, and support medical staff,” explained Jose Osorio, MD, FHRS, President of Heart Rhythm Clinical and Research Solutions, the lead author of the study. “Our study shows that adopting workflows that integrate a 3D electro-anatomical mapping system with intracardiac echocardiography can support reducing or eliminating fluoroscopy exposure during catheter ablation procedures while providing electrophysiologists and patients the confidence of uncompromised safety.”

Biosense Webster’s zero fluoroscopy workflow is the first and only such workflow available in a radiofrequency (RF) cardiac ablation device. The company received approval for this workflow from the last year, and it is available for cardiac ablation for several products in the company’s portfolio, including the Thermocool Smarttouch SF catheter. This the most commonly used ablation catheter in the world for RF ablation and is fully integrated with the CARTO 3 System. The updated workflow indicates that direct imaging guidance, such as ultrasound, may be used as an alternative to fluoroscopy.

“As Biosense Webster advances innovation for the treatment of AFib, we are thinking not only about new modalities of ablation, such as pulsed field ablation, but also how to make procedures safer, more effective and efficient. This includes zero fluoroscopy workflows, enabled by our CARTO 3 Navigation System, which allows clinicians to reduce or eliminate radiation exposure for themselves and their patients while maintaining excellent clinical outcomes,” said Jasmina Brooks, President, Biosense Webster. “The results of this real-world evidence demonstrate that a zero fluoroscopy workflow can enhance patient care while also making procedures safer and more comfortable for medical staff by removing the need to wear heavy protective gear for hours each day.”

About the Study In the study, real-world data from 16 sites participating in the REAL AF Registry – an observational, prospective, multicenter registry that assesses real-world catheter ablation clinical outcomes, including procedural efficiency, safety, and long-term effectiveness with low/zero fluoroscopy workflows and RF technologies in paroxysmal AFib patients – were analyzed. The primary endpoint of the analysis was incidence of procedure – or device-related primary adverse events (PAEs) within seven to ninety days of the ablation procedure; the secondary endpoint was the rate of acute pulmonary vein (PV) isolation. Study success was defined by meeting both safety and acute effectiveness performance goals. Low/zero fluoroscopy safety was evaluated further by a secondary analysis of data from electronic health records from 45 hospitals within the Mercy Health integrated hospital network, comparing PAEs between procedures with low fluoroscopy (two minutes or fewer) versus conventional fluoroscopy (three minutes or longer).

Results from the analysis reaffirmed the safety and effectiveness of low/zero fluoroscopy procedures. Among 208 patients included in the Real AF Registry cohort, a total of three PAEs were reported. These included one pseudoaneurysm, one PV stenosis and one hematoma. Acute PV isolation was achieved by 100% of patients in the cohort, and both safety and effectiveness endpoints were achieved. Among 299 patients in the MH cohort, secondary PAE rates were low and similar between groups, with a PAE rate of 0.8% observed among patients who underwent low fluoroscopy procedures and 0.3% among patients who had procedures utilizing conventional fluoroscopy.