Electrophysiology Ablation

Catheter-based treatment of cardiac arrhythmias — atrial fibrillation, atrial flutter, SVT, VT, WPW. 3D electroanatomic mapping (CARTO, EnSite, Rhythmia) is primary; fluoroscopy is reduced-role confirmation of catheter position, sheath transseptal, and backup. Pulsed-field ablation is rapidly displacing RF and cryo for pulmonary vein isolation since 2024.

Clinical pathway

1. Femoral venous access — multiple sheaths (diagnostic, mapping, ablation, ICE).
2. Transseptal puncture (for left-sided procedures) under ICE + fluoro.
3. 3D map acquisition — electroanatomic, supplemented by CT/MRI fusion.
4. Ablation delivery — RF, cryoballoon, or pulsed field; pulmonary vein isolation for AF, linear lines + CFAE for persistent AF, substrate for VT.
5. Testing + waiting period — confirm durable isolation, adenosine challenge for dormant conduction.

Typical systems

• Philips Azurion 7 with EP package
• Siemens Artis Q
• GE Innova 2100-IQ

EP labs run very low fluoroscopy — mapping does most of the work. Many centers run "zero fluoro" AF cases.

Room + procedure characteristics

• Procedure time: 2–4 hours (AF), 1–2 (SVT), 4–6+ (complex VT)
• Team: EP cardiologist, EP tech, anesthesia (general for AF), mapping specialist (industry or in-house)
• Dose: very low by IR standards due to mapping-first workflow

Related

• PCI
• Diagnostic Cath