Eduardo B. Saad MD, PhD, FHRS, FESC

Serviço de Arritmias e Estimulação Artificial

Centro de Fibrilação Atrial

Hospital Pró-Cardíaco - Rio de Janeiro - RJ

Ablação de FA sem Fluoroscopia

(Zero Fluoro)

eduardobsaad@hotmail.com

The Problem…

Efeitos Estocásticos e Determinísticos

• Determinísticos

• Existe um limiar de dose

• Estocásticos

• Não existe um limiar de dose

Dose em Intervencionismo

Dose no profissional

0,1 a 1,0 mSv

Radioprotective Measures

ALARA

Why do We Rely on Fluoroscopy?

Comfort in “believing where the catheter is”

Knowing where the catheter is going

Understanding (Trust) the mapping system

Use alternative imaging sources

Techniques for Fluoro Reduction

Zero Fluoro Procedure

Métodos

70 pts

FA

51 pts

SVTs

19 pts

FA parox 33 pts

FA pers 18 pts

TRN 11 pts

WPW 5 pts

ICT 2 pts

Atriot. AD 1 pt

62 ± 15 anos

60% masc

*4 pts - MP DDD

Directed Catheter Control

ICEEYES

Catheter Navigation to RA

Catheter Navigation to RA

Echo-free Space Wire in Vein

Catheter Navigation to RA

SVC Positioning

Catheter Navigation in RA

CS Reconstruction and Cannulation

Transeptal Access

Transeptal

Pentaray FAM

Multipolar Mapping- Pentarray

PVI - Contact Force

LAA Ridge Ablation

Complications - Thrombus Formation

Complications - Pericardial Effusion

Zero Fluoro - Extensive Ablation

Conclusions

• Why? – because it’s dangerous!

• When? – Always!

• How? – Change your mind!

Rely on other methods!

• 3D Mapping + ICE

ALARA = Zero Fluoro

AF Ablation Without X-ray:

#iceeyes

Video kindly given by

Guilherme SaadThank You!