(Fluoro)Less is More When It Comes to Cardiac Ablation

November 2018

Electrophysiology laboratory at the University of Ottawa Heart Institute
This new electrophysiology laboratory at the University of Ottawa Heart Institute is where electrophysiologists like Dr. Sadek are developing innovative techniques for treating patients presenting with heart conditions.

Common practice during complex arrhythmia ablation procedures, such as atrial fibrillation and ventricular tachycardia ablation, calls for the use of radiation to help visualize catheter movement and guide the electrophysiologist through critical portions of the procedure.

This type of radiation-based medical imaging is known as fluoroscopy. An X-ray beam is passed through the patient’s body and the signal is then transmitted as an image and presented on a monitor in the operating room.

Whereas fluoroscopy is an important tool for minimally invasive procedures where direct anatomic visualization inside a patient’s body is not possible, the exposure to high doses of radiation over time can pose health risks for both patient and medical personnel.

Dr. Mouhannad Sadek, a cardiac electrophysiologist working in the Division of Cardiology at the University of Ottawa Heart Institute, says he is currently performing the vast majority of ablation procedures in his laboratory without the use of radiation-based imaging technology.

The University of Ottawa Heart Institute is the first institution in Canada to systematically perform fluoroless complex ablation in patients with complex atrial arrhythmias.

- Dr. Mouhannad Sadek

In July of 2016, Dr. Sadek and his team at the Heart Institute started performing non-fluoroscopic atrial fibrillation ablation, and in 2018, they started performing non-fluoroscopic ventricular tachycardia ablation.

Dr. Mouhannad Sadek
Mouhannad Sadek, MD, is a staff electrophysiologist at the University of Ottawa Heart Institute and The Ottawa Hospital.

“The University of Ottawa Heart Institute is the first institution in Canada to systematically perform fluoroless complex ablation in patients with complex atrial arrhythmias,” says Dr. Sadek. “We are also the first hospital in the world to report on performing non-fluoroscopic complex ablation in patients with ventricular tachycardia in the setting of structural heart disease.”

To perform non-fluoroscopic ablation, both intracardiac echocardiography (ultrasound imaging) and a 3-D electro-anatomic mapping system are used to visualize critical parts of the procedure and the catheter during the ablation. When working together, this technology essentially mimics what fluoroscopy makes possible, only without the associated risk of radiation exposure.

“Nursing and support staff do not need to wear lead protection during these procedures. This reduces future cancer risk related to radiation in both patients and staff,” explains Dr. Sadek. “This is especially important in patients who require multiple procedures and imaging studies and have a cumulatively higher radiation exposure over their life-time. Young patients and pregnant patients are particularly vulnerable to radiation and thus non-fluoroscopic ablation is ideal in these situations.”

By Dr. Sadek’s own estimate, he and his team at the Heart Institute have performed more than 80 atrial fibrillation/atrial flutter ablation procedures and more than 15 ventricular tachycardia ablations using a non-fluoroscopic approach.

Realizing its potential for treating cardiac arrhythmias moving forward, Dr. Sadek adds “further work needs to be done to expand non-fluoroscopic ablation to other types of arrhythmias, and to spread our techniques to other centres in Ontario and Canada.”

Dr. Mouhannad Sadek appeared on CTV Morning Live in Ottawa on November 28, 2018.

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