Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience

Pani, Antonio; Belotti, Giuseppina; Bonanno, Carlo; Bongiorni, Maria Grazia; Bottoni, Nicola; Brambilla, Roberta; Ceglia, Sergio De; Bella, Paolo Della; Vito, G De; Malaspina, D.; Menardi, Endrj; Napoli, Velia; Negroni, Maria Silvia; Ocello, Salvatore; Orsida, Daniela; Pandozi, Claudio; Pedretti, Stefano; Penela, Diego; Pepi, Patrizia; Rossi, Luca; Rovaris, Giovanni; Scopinaro, Alice; Vincenti, Antonello; Viola, Graziana; Zacà, Valerio; Zoppo, Franco; Vergara, Pasquale

doi:10.1161/circep.117.005592

Cited by 43 publications

(39 citation statements)

References 19 publications

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“…We did not have measures of centers volume or operators’ experience; nevertheless, the procedure and fluoroscopy time were significantly different among the four study groups, whereas fluoroscopy and ablation times were significantly different among the operators. Previous studies have shown that lower operator experience leads to increased fluoroscopy use . In our registry this parameter did not impact the rate of first pass PV isolation.…”

Section: Discussionmentioning

confidence: 48%

Reproducibility of acute pulmonary vein isolation guided by the ablation index

Solimene¹,

Lepillier

Ruvo

et al. 2019

Pacing Clinical Electrophis

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Background: Atrial fibrillation (AF) ablation outcome is still operator dependent. Ablation Index (AI) is a new lesion quality marker that has been demonstrated to allow acute durable pulmonary vein (PV) isolation followed by a high single-procedure arrhythmia-free survival.This prospective, multicenter study was designed to evaluate the reproducibility of acute PV isolation guided by the AI.Methods: A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV encircling and were divided in four study groups according to operator preference in choosing the ablation catheter (a contact force [ST] or contact force surround flow [STSF] catheter) and the AI setting (330 at posterior and 450 at anterior wall or 380 at posterior and 500 at anterior wall). Radiofrequency was delivered targeting interlesion distance ≤6 mm. Results:The rate of first-pass PV isolation (ST330 90 ± 16%, ST380 87 ± 19%, STSF330 90 ± 17%, STSF380 91 ± 15%, P = .585) was similar among the four study groups, whereas procedure (ST330 129 ± 44 minutes, ST380 144 ± 44 minutes, STSF330 120 ± 72 minutes, STSF380 125 ± 73 minutes, P < .001) and fluoroscopy time (ST330 542 ± 285 seconds, ST380 540 ± 416 seconds, STSF330 257 ± 356 seconds, STSF380 379 ± 454 seconds, P < 0.001) significantly differed. The difference in the rate of first-pass isolation was not statistical different (P = .06) among the 12 operators that performed at least 15 procedures. Conclusions:An ablation protocol respecting strict criteria for contiguity and quality lesion results in high and comparable rate of acute PV isolation among operator performing ablation with different catheters, AI settings, procedure, and fluoroscopy times. K E Y W O R D S ablation index, atrial fibrillation, catheter ablation, reproducibility 874

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Section: Discussionmentioning

confidence: 48%

Reproducibility of acute pulmonary vein isolation guided by the ablation index

Solimene¹,

Lepillier

Ruvo

et al. 2019

Pacing Clinical Electrophis

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“…27 In their study, Raju et al demonstrated that general anaesthesia, transoesophageal echocardiography and contactforce mapping catheters may all facilitate a minimised fluoroscopic approach among AF ablation patients. 28 In this population, complete zero-fluoroscopy was possible in cases with patent foramen ovale (PFO), which was documented in 36% of patients. 28 In 2016, we published a study of 442 consecutive patients who were referred for radiofrequency catheter ablation during a 5-year period (2009-2013).…”

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confidence: 94%

“…28 In this population, complete zero-fluoroscopy was possible in cases with patent foramen ovale (PFO), which was documented in 36% of patients. 28 In 2016, we published a study of 442 consecutive patients who were referred for radiofrequency catheter ablation during a 5-year period (2009-2013). 12 The patients were included in a retrospective observational study, where the first 145 patients (group 1) were treated only under fluoroscopic guidance; the other 297 patients (group 2) were treated with a non-conventional mapping system.…”

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confidence: 94%

A New Era in Zero X-ray Ablation

Mascia

Giaccardi

2020

Arrhythm Electrophysiol Rev

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In this article, the authors focus on the importance of the zero X-ray ablation approach in electrophysiology. Radiation exposure related to conventional transcatheter ablation carries small but non-negligible stochastic and deterministic effects on health. Non-fluoroscopic mapping systems can significantly reduce, or even completely avoid, radiological exposure. The zero X-ray approach determines potential clinical benefits in terms of reduction of ionising radiation exposure, as well as safe technical advantages. The use of this method can result in similar outcomes when compared to the conventional fluoroscopic technique. These results are achieved without altering the duration, or compromising the effectiveness and safety, of the procedure. The zero X-ray ablation approach is a feasible and safe alternative to fluoroscopy, which is often only used in selected cases for troubleshooting. The non-fluoroscopic approach is considered a milestone for cancer prevention in ablation procedures.

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“…However, the widespread use of non-fluoroscopic mapping systems has introduced the possibility of performing this procedure without the need for fluoroscopy, without affecting the efficacy and safety of the procedure. [31][32][33] In particular, the most used electroanatomical mapping system are currently Carto (Biosense Webster, Johnson and Johnson, USA), EnSite Precision (Abbott, USA) and Rhythmia (Boston Scientific, USA). All these systems are characterized in their updated version by the ability to perform a magnetic and electrical three-dimensional (3D) anatomical reconstruction of the cardiac chambers and real-time visualization of the catheters.…”

Section: Future Perspectivesmentioning

confidence: 99%

<p>Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives</p>

Matta¹,

Devecchi²,

Vecchi³

et al. 2020

RRCC

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Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common, highly symptomatic paroxysmal supraventricular tachycardia. Despite pharmacological treatment and vagal maneuvers for acute termination, catheter ablation has emerged as the first line treatment for the cure of AVNRT episodes. Several studies during recent years have investigated the efficacy, safety and long-term effect of both radiofrequency ablation and cryoablation of the slow pathway for the treatment of AVNRT. Innovations such as mapping systems and dedicated catheters have contributed by extending the indication to AVNRT ablation, even in particular subset populations such as children and congenital heart disease patients. We performed this review with the aim aim of summarizing and discussing current perspectives on the treatment of AVNRT, mainly focusing on catheter ablation energy sources and long-term results.

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Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience

Abstract: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.

Cited by 43 publications

References 19 publications

Reproducibility of acute pulmonary vein isolation guided by the ablation index

Reproducibility of acute pulmonary vein isolation guided by the ablation index

A New Era in Zero X-ray Ablation

<p>Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives</p>

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