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Eur Heart J Case Rep. 2018 Nov 26;2(4):yty137. doi: 10.1093/ehjcr/yty137. eCollection 2018 Dec.

Fluoroscopy-free cryoablation of atrial fibrillation guided solely by transoesophageal echocardiography: a case report.

Author information

1
Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, 1st Floor KGV Wing, London, UK.
2
Department of Cardiology, London Bridge Hospital, 27 Tooley Street, London, UK.
3
William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK.

Abstract

Background:

Atrial fibrillation (AF) ablation has been shown to be possible using minimal or no fluoroscopic imaging for guidance. However, the techniques previously described focus on radiofrequency ablation or rely on the use of resource-heavy technology such as intra-cardiac echocardiography. We describe the first reported case in the literature of successful fluoroscopy-free AF cryoablation guided solely by transoesophageal echocardiography (TOE).

Case summary:

A 65-year-old gentleman underwent cryoablation of paroxysmal AF using TOE guidance only with no use of fluoroscopy. Transoesophageal echocardiography was used in all stages of the procedure including guidance for transseptal puncture, ensuring balloon position in the pulmonary veins, and checking for post-procedure pericardial effusion. After 5 months of follow-up, the patient remains in sinus rhythm and has discontinued all antiarrhythmic and anticoagulant medication.

Discussion:

This case demonstrates for the first time the feasibility of fluoroscopy-free cryoablation using only TOE for guidance.

KEYWORDS:

Ablation; Atrial fibrillation; Case report; Echocardiography; Fluoroscopy-free

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