Hi, my name is Jim Chung. I'm a professor of medicine at Weill Cornell Medicine in New York, and I'm going to give you my three-minute perspective on how to get to zero or near zero fluoroscopy usage in your EP laboratory. Fluoroscopy usage is not something we spend a lot of time thinking about, but it can impact your health and the health of your patients, nurses, and staff. The effects of radiation can increase the risks of cancer. For patients, EP procedures are unlikely to be the only radiation-generating procedures that they'll be undergoing. For EPs, an annual dose of 5 millisieverts over a 20-year period is associated with an excess risk of cancer of 1%. Finally, there are occupational health risks of back and knee injuries associated with wearing lead among physicians, nurses, and staff who work in the EP lab. The greatest barrier that I've seen to achieving zero fluoroscopy in EP cases is not related to technology, but rather mindset. If you adopt the proper mindset, you will find that we already have the tools to minimize fluoroscopy usage in a safe and expeditious way. First, intracardiac echocardiography is a tremendous tool. Where this is particularly evident is with transeptal punctures. For some operators, this remains one aspect of ablation procedures where they still like to use fluoroscopy. And I believe that ice-guided transeptal puncture without fluoroscopy is not only simple, but safer. You first start with an SVC view, which involves clocking the ice catheter from the home view to show the left atrium, and then performing a posterior and rightward tilt to reveal the SVC-RA junction and long axis. This permits you to position the guide wire, needle, and sheath at the start of the transeptal. Gradual release of the posterior and rightward tilt of the ice catheter as you pull down into a fossa will allow you to follow the sheath tip. Once the desired alignment of the needle towards the left atrium and tenting are confirmed, transeptal puncture is performed. Once you have crossed into the left atrium with your dilator, you can directly visualize with ice the moment that the sheath has also crossed into LA, which is when the tenting is released. Prior to pushing the sheath, ice will show you how much posterior clearance you have so that you can minimize the risk of perforation by redirecting the needle as needed. Second, electroanatomic mapping systems permit visualization of diagnostic and ablation catheters in 3D space, which really obviate the need for fluoroscopy. Use these systems to your full potential. Finally, if in the rare cases where you feel that you do need to use fluoroscopy, then remember to lower your frame rates, eliminate unnecessary fluoroscopy while you're planning, and collimate to the region of interest and shield yourself. I hope that these key points will get you started to minimizing and eliminating fluoroscopy in many of your EP procedures. Remember to get into the proper mindset, and you, your patients, and your staff will really benefit. Thank you for listening.

fluoroscopy reduction

radiation exposure

occupational hazards

intracardiac echocardiography

electroanatomic mapping systems