AimsAim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure.Methods and resultsWe performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTM navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0–0.08 vs. 8.87 mSv, iqr 3.67–22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0–12 vs. 859 s, iqr 545–1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs.ConclusionThis is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy.Trial registrationclinicaltrials.gov Identifier: NCT01132274.

In this nonrandomized, open-label clinical study, despite intraventricular electrical and mechanical dyssynchrony, extensive LV remodeling at baseline negatively impacted CRT results in terms of LV function improvement and incidence of cardiac events at follow-up.

drugs (AADs) after ablation. 2-6 A durable PV isolation (PVI) is optimized by continuity in the ablation lesion deployment along the circumferential isolation line. 7, 8 Adequate point-by-point information on lesions could be necessary to guarantee the transmurality, continuity, and durability of ablation. Recently, an automated ablation lesion tagging module has been developed. 9 It incorporates indirect parameters of lesion formation that can be indexed by the user, according to the ablation strategy. Our aim A blation strategies that target the pulmonary veins (PVs) are the cornerstone for most atrial fibrillation (AF) ablation procedures, and electrical isolation with at least evidence of entrance block should be the goal of the procedure. 1 A 12-month success rate, defined as the freedom from AF and/or atrial tachycardia (AT) events, appears to be related to the number of procedures and the optimal contact of the ablation catheter with the tissue, and only moderately to the maintenance of antiarrhythmic Fabrizio Guarracini, MD, PhD; Maria Grazia Bongiorni, MD Background: Our aim was to evaluate the clinical outcome of paroxysmal atrial fibrillation (AF) ablation with contact force technology, using an automated lesion tagging system (VISITAG TM module) with strict criteria of catheter stability.

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