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All the king's men (and women): Fluoro-less leadless pacemaker implant in a severely obese patient.
J Cardiovasc Electrophysiol
October 2024
Division of Cardiac Electrophysiology, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Introduction: Severe obesity presents significant challenges in imaging and delivery of therapy, including pacemaker implant.
Methods And Result: We present our experience implanting a leadless pacemaker (LP) in a severely obese man presenting with heart block. We describe our multidisciplinary approach using right internal jugular venous access and transesophageal imaging in lieu of fluoroscopy which failed to provide workable images in this instance.
Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives.
Endosc Int Open
August 2022
Pancreatobiliary endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCSS San Raffaele Scientific Institute, Milan, Italy.
Therapeutic EUS (t-EUS) is increasingly being adopted in clinical practice in tertiary referral centers; however, little is known about radiation exposure (RE) metrics and diagnostic reference limits for it. Kerma-area product (KAP [Gy·cm ]), Air Kerma and fluoroscopy time were retrospectively evaluated for all consecutive t-EUS procedures performed in San Raffaele Institute between 2019 and 2021. For EUS-guided choledochoduodenostomies (EUS-CDS) and gastroenterostomies (EUS-GE), an equal number of endoscopic retrograde cholangiopancreatographies (ERCPs) plus metal stenting and duodenal stents were included respectively for comparison.
View Article and Find Full Text PDFFluoroless left atrial access for radiofrequency and cryoballoon ablations using a novel radiofrequency transseptal wire.
J Interv Card Electrophysiol
June 2022
AMITA Health St. Joseph Hospital, 1975 Lin Lor Ln Ste. 155, Elgin, IL, 60123, USA.
Purpose: Conventional catheter ablation for atrial fibrillation requires fluoroscopy, which has inherent risks of radiation exposure to patients and medical staff. Optimization of fluoroscopy parameters and use of three-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) have helped to reduce radiation exposure; however, despite growing evidence, there are still concerns about safety and added procedure time associated with fluoroless procedures, particularly in left-sided ablations, due to the potential risk of complications. Herein, we report our initial experience using a radiofrequency (RF) wire for completely fluoroless radiofrequency ablation (RFA) and cryoballoon ablation (CBA).
View Article and Find Full Text PDFOutcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy.
Gastroenterol Rep (Oxf)
December 2020
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Background: Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy.
View Article and Find Full Text PDFNear-zero Fluoroscopic Approach for Laser Balloon Pulmonary Vein Isolation Ablation: A Case Study.
J Innov Card Rhythm Manag
April 2020
Division of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA.
Fluoroscopy remains a cornerstone imaging modality for catheter placement and positioning in electrophysiology device and ablation procedures. However, efforts are being made to reduce the cumulative exposure to radiation in the patient and physician alike. We present the case of a 59-year-old male patient with hypertension, chronic kidney disease, and paroxysmal atrial fibrillation who underwent successful near-fluoroless laser balloon (LB) pulmonary vein isolation (PVI) ablation.
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