Radiofrequency ablation is a well-established method and is increasingly used in the treatment of tachyarrhythmia. Traditionally, it is done by placing fluoroscopy-guided intracavitary catheters. Over the years, however, a number of problems related to exposure to radiation have become more evident, such as cataracts, genetic mutations, cancer. It is not by chance that the number of tumors in the left cerebral hemisphere, which receives the greatest amount of radiation, is greater than in the right hemisphere, in interventionists. It is important to remember that the risk of cancer is linear with exposure, without a defined threshold, and that there is a cumulative effect. In longer procedures, even severe skin lesions can develop in patients. To reduce these risks to patients and the medical staff, several actions were taken: fluoroscopic devices and methods with less radiation, personal protective equipment, such as an apron, thyroid protection, goggles, cap and even leaded gloves. Protection increased, but at the expense of orthopedic problems due to the weight that was carried, in so many procedures, for so long. New solutions were created, such as suspended lead aprons. But along with this increase in personal protection, the idea of effectively performing the procedure with the least amount of radiation possible gained momentum. For this, the development of three-dimensional mapping systems was the driving force required. This, associated with the use of ablation catheters by contact, made it possible to perform procedures, including complex ones, manipulating catheters and applying energy efficiently and safely, without requiring fluoroscopic imaging. In less complex procedures, especially on the right side of the heart, ablations without fluoroscopy were described. , In pregnant women, it has become a feasible solution. Even for the more complex procedures, “near-zero” fluoroscopy was recommended. “Near-zero” because it was still necessary to use fluoroscopy at times, such as transseptal puncture, for example.
At the same time, ultrasound has been increasingly used in invasive cardiac procedures and, more specifically, in electrophysiology. Vascular ultrasound is used to support vascular punctures and to reduce AV fistulas and pseudoaneurysms. Transesophageal echo is useful to rule out atrial appendage thrombus and to assist transseptal puncture. Even more useful is intracardiac echo, which assists transseptal puncture, shows pulmonary vein ostia, rules out pericardial effusion, shows recesses during cavotricuspid isthmus ablation and confirms adequate catheter contact.
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