The Role of 3D Mapping Technology and Fluoro Reduction in the Electrophysiology World

Citation : Carlo Pappone, Gabriele Vicedomini, Vincenzo Santinelli

Catheter ablation has become a standard therapeutic option for the management of many arrhythmias, including atrial fibrillation, atrial tachycardia and ventricular tachycardia with an increasing number of ablation procedures worldwide. Although conventional fluoroscopy has been and remains the main technology for catheter tracking, concerns about long-term effects of radiation exposure on patients and operators have stimulated the use of nonfluoroscopic 3D systems and interest in their use is growing rapidly worldwide. Beside the associated significant X-ray exposure, fluoroscopy only provides 2D orientation. For complex anatomies and substrates mapping, nonfluoroscopic 3 dimensional technologies are routinely used to facilitate catheter navigation for successful ablation while minimizing or eliminating fluoroscopy exposure. There are many 3D fluoroless systems available such as the CARTO and Ensite systems which have been conceived to provide the ability to monitor catheter movement without fluoroscopy, as well as to create cardiac geometry and monitor marked mapping and ablation points. New software upgrades to nonfluoroscopic 3D mapping have resulted in very detailed cardiac chambers, potentially eliminating preprocedure computed tomography imaging. More recently, a novel sensor-based 3D catheter tracking system integrating 3D non-fluoroscopic catheter navigation into prerecorded conventional 2D fluoroscopy (MediGuide technology) has been proposed with the possibility of a procedure without fluoroscopy. This chapter will summarize the most recent developments and the latest findings in catheter navigation and 3D electroanatomic mapping systems. Although these new systems are routinely used worldwide, in our opinion they cannot completely replace careful interpretation of electrophysiology data particularly in the management of complex arrhythmias.