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Near-zero fluoroscopy catheter ablation for atrial fibrillation achieves 26-second radiation exposure, <1% complications, and durable one-year arrhythmia-free survival.
A prospective registry of 450 patients demonstrates that near-zero fluoroscopy catheter ablation for atrial fibrillation (AF) can be performed efficiently and safely using advanced 3D electroanatomical mapping and an ultra-low-dose radiation protocol—without intracardiac echocardiography or non-fluoroscopic catheter tracking systems.
Catheter ablation remains central to rhythm control in AF, but cumulative radiation exposure is a growing concern for both patients and electrophysiologists. The SHORT LOOK study evaluated whether a simplified pulmonary vein isolation (PVI) workflow—using the CARTO 3 platform alone—could reliably achieve near-zero fluoroscopy in first-time AF ablation. This investigator-initiated, single-center study enrolled consecutive people undergoing first-time PVI.
Baseline assessments encompassed clinical evaluation, laboratory testing, electrocardiography (ECG), echocardiography, and Euro quality of life-visual analog scale (EQ-VAS) scoring. The key efficacy endpoint was median fluoroscopy time, while the key safety endpoint was a composite of procedure-linked death or vascular, cardiovascular, or neurological complications. Secondary measures included 1-year freedom from atrial arrhythmia (>30 seconds), procedural duration, fluoroscopy dose, and quality-of-life changes.
The streamlined workflow delivered strong efficiency with a median procedure time of 57 minutes. Radiation exposure was exceptionally low, with a median fluoroscopy time of just 26 seconds and a median dose of 9.1 µGy·m². The overall complication rate was below 1%, and no major adverse events or procedure-related deaths were reported. Paroxysmal atrial fibrillation shows higher sustained AT/AF-free rates at both 3 and 12 months compared to persistent atrial fibrillation, indicating better long-term rhythm control (Table 1).
Patients also experienced remarkable improvement in EQ-VAS scores, reinforcing meaningful clinical benefit. To sum up, ar-zero fluoroscopy AF ablation is achievable using conventional tools already available in electrophysiology laboratories. The approach nearly eliminates radiation exposure, maintains procedural speed, preserves safety, and delivers durable one-year outcomes—without the cost or complexity of additional imaging or tracking technologies.
Journal of Cardiovascular Electrophysiology
Near-Zero-Fluoroscopy Ablation of Atrial Fibrillation Without ICE or Non-Fluoroscopic Tracking Systems: Findings From the SHORT LOOK Registry
Martin Borlich et al.
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