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Volume 14
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10.3390/diagnostics14020182
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Review

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review

by
Alberto Preda
1,
Eleonora Bonvicini
2,
Elena Coradello
2,
Alessio Testoni
1,
Lorenzo Gigli
1,
Matteo Baroni
1,
Marco Carbonaro
1,
Sara Vargiu
1,
Marisa Varrenti
1,
Giulia Colombo
1,
Marco Paolucci
1,
Patrizio Mazzone
1 and
Fabrizio Guarracini
1,*
1
Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
2
Division of Cardiology, Department of Medicine, Verona University Hospital, 37129 Verona, Italy
*
Author to whom correspondence should be addressed.
Diagnostics 2024, 14(2), 182; https://doi.org/10.3390/diagnostics14020182
Submission received: 16 December 2023 / Revised: 7 January 2024 / Accepted: 11 January 2024 / Published: 14 January 2024
(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Cardiac Arrhythmias)
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Abstract

Fluoroscopy has always been the cornerstone imaging method of interventional cardiology procedures. However, radiation exposure is linked to an increased risk of malignancies and multiorgan diseases. The medical team is even more exposed to X-rays, and a higher incidence of malignancies was reported in this professional group. In the last years, X-ray exposure has increased rapidly, involving, above all, the medical team and young patients and forcing alternative fluoroless imaging methods. In cardiac electrophysiology (EP) and pacing, the advent of 3D electroanatomic mapping systems with dedicated catheters has allowed real-time, high-density reconstruction of both heart anatomy and electrical activity, significantly reducing the use of fluoroscopy. In addition, the diffusion of intracardiac echocardiography has provided high anatomical resolution of moving cardiac structures, providing intraprocedural guidance for more complex catheter ablation procedures. These methods have largely demonstrated safety and effectiveness, allowing for a dramatic reduction in X-ray delivery in most arrhythmias’ ablations. However, some technical concerns, as well as higher costs, currently do not allow their spread out in EP labs and limit their use to only procedures that are considered highly complex and time-consuming and in young patients. In this review, we aim to update the current employment of fluoroless imaging in different EP procedures, focusing on its strengths and weaknesses.
Keywords: 3D electroanatomic mapping system; ALARA; catheter ablation; fluoroless; intracardiac echocardiography; radiation exposure 3D electroanatomic mapping system; ALARA; catheter ablation; fluoroless; intracardiac echocardiography; radiation exposure

Share and Cite

MDPI and ACS Style

Preda, A.; Bonvicini, E.; Coradello, E.; Testoni, A.; Gigli, L.; Baroni, M.; Carbonaro, M.; Vargiu, S.; Varrenti, M.; Colombo, G.; et al. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics 2024, 14, 182. https://doi.org/10.3390/diagnostics14020182

AMA Style

Preda A, Bonvicini E, Coradello E, Testoni A, Gigli L, Baroni M, Carbonaro M, Vargiu S, Varrenti M, Colombo G, et al. The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics. 2024; 14(2):182. https://doi.org/10.3390/diagnostics14020182

Chicago/Turabian Style

Preda, Alberto, Eleonora Bonvicini, Elena Coradello, Alessio Testoni, Lorenzo Gigli, Matteo Baroni, Marco Carbonaro, Sara Vargiu, Marisa Varrenti, Giulia Colombo, and et al. 2024. "The Fluoroless Future in Electrophysiology: A State-of-the-Art Review" Diagnostics 14, no. 2: 182. https://doi.org/10.3390/diagnostics14020182

APA Style

Preda, A., Bonvicini, E., Coradello, E., Testoni, A., Gigli, L., Baroni, M., Carbonaro, M., Vargiu, S., Varrenti, M., Colombo, G., Paolucci, M., Mazzone, P., & Guarracini, F. (2024). The Fluoroless Future in Electrophysiology: A State-of-the-Art Review. Diagnostics, 14(2), 182. https://doi.org/10.3390/diagnostics14020182

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