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Technical Factors in Cardiac EP Ablation Procedures

Updated: Jun 23, 2023

Seeing EP from Every Angle

The advancement of technology and the evolution of techniques in ablative therapy has been the result of adopting new systems and workflows, which provide a more comprehensive understanding of arrhythmias. Let's look at the top three imaging technologies.


Live X-ray, commonly termed "fluoro," was the initial imaging modality used during cardiac catheterization and cardiac electrophysiology procedures. It is the real-time imaging modality of choice with the benefit of its non-invasive and a standard system offering in the EP lab.

However, the inherent risk of ionizing radiation, a limiting 2-dimensional display, and the inability to differentiate fine anatomical structures have pushed operators to utilize more advanced technologies in order to overcome the limitations of fluoroscopy.

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ICE is a readily utilized imaging tool during EP procedures. ICE offers multiple procedural advantages, mainly real-time imaging from inside the heart. The result is high-quality imaging from catheter-based transducers.

ICE has proven to be extremely valuable in monitoring for complications and equipment guidance --

Notably, atrial septal imaging to gain transseptal access from the right atrium to the left atrium. Additionally, the ability to view the catheter position and tissue contact is extremely valuable throughout the procedure.

To learn more about ICE and imaging in the EP Lab enroll in the online self-paced course:



Mapping systems provide an accurately displayed 3-dimensional virtual anatomy of the heart combined with cardiac signal data, without the use of ionizing radiation.



  • Collection of MASSIVE amounts of data applied to 3D map.

  • Ability to analyze complex arrhythmias utilizing software algorithms.

  • Visualization of catheters to reduce the need for fluoro.

  • Integration of other modalities (fluoro, ultrasound, CT scan, contact force).

  • Various types of mapping display: VOLTAGE vs. TIMING/ACTIVATION vs. PROPAGATION.

The technical advancements of imaging modalities utilized during cardiac EP procedures are not meant to eliminate each other but complement one another. Although the decrease in ionizing radiation is highly desirable, the goal is to use each modality for its highest purpose so that when used together procedures are safer and more technically accurate. EP professionals should understand each modality and apply that knowledge to positively impact patient outcomes.

Read more from Regina:


About the Author...

Regina Kiefer, RT(CV), RCES, RCIS is the Director of Professional Development at CHART Healthcare Academy.

Regina is dedicated to bringing EP training to new #EPeeps through the CHART Plus™+ hospital EP Lab educational programs and the CHART EP: LIVE mini-courses.

Connect with Regina Kiefer on LinkedIn for information on CHART Certified Coaching.

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