Non-fluoroscopic catheter ablation: A randomized trial

Abstract

BackgroundCatheter ablation provides curative treatment for tachyarrhythmias. Fluoroscopy, the method used for this, presents several risks. The electroanatomical mapping (MEA) presents a three-dimensional image without using X-rays, and may be adjunct to fluoroscopy.ObjectivesWe evaluated the possibility of performing catheter ablation with the exclusive use of electroanatomical mapping (MEA), dispensing with fluoroscopy. We compared the total time of procedure and success rates against the technique using fluoroscopy (RX) with emission of X-rays.MethodsRandomized, unicentric, uni-blind study of patients referred for tachyarrhythmia ablation.ResultsTwelve patients were randomized to the XR group and 11 to the EAM group. The mean age was 48.5 (±12.6) vs 46.3 (±16.6) (P = ns). Success occurred in 11 patients (91.7%) in the RX group and 9 (81.8%) in the MEA group (P = 0.46). The procedure time in minutes was higher in the MEA group than in the RX group (79-47-125min vs 49-30-100min; P = 0.006). The mean fluoroscopy time was 11 ± 9 min versus zero (RX vs MEA: P < 0.001). The mean radiofrequency applications were lower in the RX group against the MEA group (6 ± 3.5 × 13.2 ± 18.2 p < 0.019). There were no complications.ConclusionMEA opened new therapeutic possibilities for patients with arrhythmias, reducing the risk of radiation. In this study, it was possible to demonstrate that it is feasible to perform ablation only with the use of MEA, with similar success with fluoroscopy, at the expense of a longer procedure time.

Zero fluoroscopy approach versus fluoroscopy approach for cardiac arrhythmia ablations: A systematic review and meta‐analysis

“…Recurrence‐free survival rates were reported in 12 studies 3,5,6,8,10–12,17–22 . Mean procedure times were reported in 15 studies 3–8,10–13,17–22 . Complication rates were reported in 13 studies 3–7,9,11–13,19–22 .…”

“…Fourteen of the 16 studies included in this meta‐analysis (2105 ZF, 3715 CF/LF) 3–9,11,12,17,19–22 reported acute procedure success rates. There was no significant difference in acute procedure success between ZF and CF/LF (OR: 1.10, 95% CI: 0.75–1.59, I 2 : 0.0%, p = .628) (Figure 2).…”

“…In light of the emerging use of three‐dimensional electroanatomic and impedance ranging mapping systems, 2 zero fluoroscopy (ZF) approaches for CA have been advocated to eliminate risks associated with radiation exposure. Previously published data regarding the periprocedure and postprocedure outcomes with ZF approaches have shown mixed results in regard to arrhythmia‐free survival, procedure times, and complications 3–13 …”

The Role of Digoxin in the Successful Termination of a Resistant Maternal Atypical Av Nodal Reentry Tachycardia

“…15 Although, it requires X ray for visualization in most conventional cases, it can also be offered with fetal shield during the procedure, in the later half of pregnancy. 16 Three-dimensional mapping systems can also be used as the navigational modality minimizing or obviating the need for any exposure to ionizing radiation altogether. EPS-RFA has proven success and it has significantly reduced the mortality rate in SVT patients.…”

Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment

“…The traditional form of catheter ablations involves the radiological modality called fluoroscopy. Fluoroscopy is utilized to position the catheter in the heart [ 28 ]. This presents a significant problem as the X-ray emissions from this procedure are dangerous to the fetus [ 29 ].…”