ABC | Volume 114, Nº6, June 2020

Original Article Saad et al. Zero Fluoroscopy Catheter Ablation for Atrial Fibrillation and Supraventricular Arrhythmias Arq Bras Cardiol. 2020; 114(6):1015-1026 Video2– Zero-fluorotransseptalpuncture.AftertheICEcatheter ispositioned intheRA,theLAandSVCarevisualized.Theguidewirearrives intheSVC,followedbysheathadvancement. Sheathposition in theSVC isconfirmedbysaline injection,showingcraniocaudalflow.Septal tentingandperforationareshown, followedbywireadvancement to the leftPV.Thesheath is then confirmed in the LAcavity by saline bubble visualization.The second transseptal sheath is then pulled down from the SVC to the septum, followed by a second septal perforation. Access the video here: https://bit.ly/2XWhIbE. Video 3 – High definition anatomic reconstruction of LA and PVs. With the multipolar mapping catheter, the anatomic acquisition is obtained by sequentially moving the mapping catheter, while the ablation catheter is parked in the mitral annulus. Two different views are shown (posterior and superior). Access the video here: https://bit.ly/2XWhIbE. which were ablated when present. In patients with documented typical atrial flutter, the ablation catheter was then pulled to the RA, and a linear, ICE guided lesion was performed in the cavotricuspid isthmus (CTI). Detailed ICE visualization was essential to avoid tangling the catheter with pacemaker leads, when present. In challenging anatomies (e.g., prominent Eustachian ridge or the presence of pouches), ICE is critical to ensure adequate tissue contact throughout the CTI. Regaining access to the LA, whenever needed, was easily accomplished using previously tagged transeptal access sites in the EA map. During the procedure, to ensure safety, the ICE catheter was frequently prolapsed to the right ventricle 1018