Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

Abstract

INTRODUCTIONRadiofrequency catheter ablation (RFCA) is a first-line therapeutic option for supraventricular tachycardia (SVT).(1) It is conventionally performed under fluoroscopy. The amount of exposure to fluoroscopy is highly dependent on multiple variables, such as operator experience and the complexity of the arrhythmia substrate.(2) As exposure to radiation during such procedures increases the lifetime risk of fatal malignancies, skin injuries and cataract, it poses a palpable hazard to both patients and medical staff.(3) This emphasises the importance of employing all possible measures to minimise exposure to ionising radiation.Recent advances in technology have led to the development of non-fluoroscopic three-dimensional (3D) mapping systems to guide ablation during prolonged electrophysiological procedures, such as pulmonary vein isolation for atrial fibrillation and mapping of atypical atrial flutter and ventricular tachycardia. These 3D mapping systems help physicians to better comprehend complex arrhythmias and develop appropriate ablation strategies. These systems have also been proven to substantially reduce ionising radiation exposure. Data on the use of non-fluoroscopic systems (NFS) in Singapore is limited. Therefore, the aim of the present study was to determine the consistency and applicability of the aforementioned latest findings in our local setting. The specific aims of the present study were (a) to determine the procedure and fluoroscopy times, and ionising radiation exposure of patients who underwent RFCA for SVT using NFS as compared to those using conventional fluoroscopy (CF); and (b) to compare atrioventricular nodal reentrant tachycardia (AVNRT) ablation and atrioventricular reentrant tachycardia (AVRT) ablation. METHODSThe present study was a prospective analysis of patients who underwent electrophysiology (EP) study of paroxysmal SVT at our institution from January 2012 to March 2014. Patients with AVNRT and AVRT were enrolled and a total of 200 consecutive patients, aged 11-86 years, who underwent RFCA were included in this study. All patients (or parents, if the patient was underage) gave informed consent.Each patient underwent RFCA in the fasted and non-absorptive state, and under intravenous sedation with midazolam and fentanyl. Local anaesthetic with lignocaine was administered at the vascular access sites, which were the femoral venous site for all patients. Some patients also had femoral arterial access if the operator selected a retrograde aortic approach to obtain access to the left side of the heart. The decision for NFS usage was operator-dependent and made before the EP study. The choice of NFS, either EnSite TM NavX

Zero-fluoroscopy approach for ablation of supraventricular tachycardia using the Ensite NavX system: a multicenter experience

“…Ensite NavX system can be used for accurate navigation. The advantages of three dimensional mapping system has been widely discussed in previous studies [8,12,[25][26][27][28][29]. According to our experience, the guidewires Fig.…”

“…Ventricular and atrial stimulation protocols were used to assess conduction properties and arrhythmia inducibility. Standard protocols and procedures, depending on the arrhythmic substrate, were used for all ablation procedures [12]. Fluoroscopy was used throughout all phases of the procedure, including confirmation of the guidewire position, electrophysiological studies, mapping, and ablation.…”

Long-standing persistent atrial fibrillation ablation without use of fluoroscopy in a patient with cor triatriatum

“…Furthermore, as the volume of atrial fibrillation procedures rises, concern over patient and staff radiation exposure continues to increase 2, 12, 13. While nonfluoroscopic guidance systems, such as ICE, TEE, and 3D EAM, have been increasingly used in catheter ablation procedures to reduce or completely eliminate fluoroscopy,4, 5, 6, 7, 8, 14 transseptal access is often regarded as the main challenge in completely nonfluoroscopic catheter ablation 15 . This step requires visualization of the drop-down of the device tip from the brachiocephalic vein or SVC to the fossa ovalis, which is traditionally performed under fluoroscopic guidance.…”

Clinical approach to the knotting diagnostic quadripolar catheter during zero‐fluoro electrophysiological study

“…Increasingly, catheter ablations can be performed with minimal or even zero fluoroscopy, leading to significant reduction in radiation dose as well as fluoroscopy time . In addition, studies have shown that the minimal fluoroscopic technique was safe and did not compromise acute success rates …”