Atrial Fibrillation Ablation - How do I do it

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Information about Atrial Fibrillation Ablation - How do I do it
Health & Medicine

Published on March 6, 2014

Author: JoseOsorio16



Atrial fibrillation ablation is a procedure performed to attempt to cure afib. It is traditionally performed using fluoroscopy (X-Ray) to guide, and exposure to radiation is a concern.
In order to minimize and sometimes completely avoid the use of radiation during the procedure newer techniques using the mapping systems have been developed.
This presentation shows some of the techniques I use to minimize fluoroscopy during ablation. This was presented at a course for electrophysiology fellows.

Jose Osorio, MD

   Elective Procedure Potentially serious or even fatal complications SAFE PROCEDURE - #1 Priority  Specially if you are just out of a fellowship

 It has to be safe for you as well

Afib ablation    100% fluoroscopic navigation Mapping system used for “tagging” No ultrasound

 3 months out of fellowship  Exceeded the radiation exposure at the VA  Making changes was not optional  Changes  Rad-Pad  Better use of shields/Rad Tech  Carto

  There are many ways How do other EPs do?  Visit other sites  Literature  Afib ablation during fellowship  You should not stop there  Constant improvement

 CS catheter placement  “Trust” the 3D map  You really don’t need the fluoroscopic images  Know the anatomy  really well  Intracardiac Echo

      FAM VISITAG™ MODULE Curve Visualization UNIVU™ MODULE Intracardiac Echo Cartographer

      65 yo man Typical flutter ablation 2 years ago Paroxysmal Afib shortly after No CAD Failed Bystolic and diltiazem Very symptomatic

Follow guidelines: - Try drug therapy first - Informed Consent / Patient education - The more informed the better No unrealistic expectations


“FAM”of PVs

“FAM”of PVs

 Analyze PACs Entrance and Exit Block

Local PV capture with exit block

Tags of Isolation Points

    Patient selection Rely heavily on Carto Single Transeptal Endpoints

 Safe Procedure  Patient  You and the Staff  3D mapping tools  Fluoroscopy reduction  EP Fellowship  The beginning of your journey as an EP

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