Background: Radiofrequency catheter ablation (RFCA) is a well-established treatment
for atrial fibrillation (AF). Fluoroscopy, a widely used imaging method for RFCA,
has significant implications for human health. Although no fluoroscopy or near-zero
fluoroscopy strategies have gained popularity, they have limitations, such as long
procedure times, additional equipment, and expertise. A simple and cost-effective
radiation reduction method is needed for treating AF and is compatible with the daily
workflow. We aimed to compare the efficacy and safety of fluoroscopy-free and lead
apron-free (LAF) after transseptal puncture AF ablation with conventional ablation
(CON). Methods: This retrospective study included all patients who underwent RF catheter
AF ablation. The lead apron used for protection was removed immediately before 3D
reconstruction of the left atrium (LA) after transseptal puncture (TSP), while fluoroscopy
was performed on stand-by and locked-in. The pulmonary vein isolation (PVI) was performed
using a 3D mapping system, a multielectrode catheter, and a Smart Touch contact force
(CF) sensing catheter, via the lead-apron-free (LAF) method, which is similar to the
conventional ablation (CON) method. Results: This study enrolled 152 consecutive patients,
with 72 and 80 patients in the LAF and CON groups, respectively. The LAF group demonstrated
significantly lower values in total fluoroscopy time (6.9 vs. 14 min, P<0.001) and
dose area product (DAP) values (15.4 +/- 12.1 vs. 31.5 +/- 17.4 G/m(2), P<0.001) than
the CON group. However, there was no significant difference in the total procedure
time (83.6 +/- 21.1 vs. 77.2 +/- 11.4 min, P=0.12) between the two groups. Only four
procedures (5.5%) required repositioning of the apron, and no complications were observed
with the LAF method. Pulmonary vein isolation was achieved in all patients. Conclusions:
The LAF method reduced fluoroscopy use compared with CON, with no change in procedure
time or efficacy.
