Conventional fluoroscopy-guided versus zero-fluoroscopy catheter ablation of supraventricular tachycardias

Abstract

Purpose The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT). Methods 584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared. Results The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0%; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators' preferences. Conclusion The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.

Efficacy and safety of pulsed field ablation for accessory pathways: a pilot study

“…16 We applied repetitive PFE delivery near the target in order to create an expanded range of lesions. 15 , 17 In this study, we suggest that the 3-PFA modality for bonus lesions is rational for the elimination of APs. Although the cumulative damage mainly determined the effects of PFA protocol, the effects of a given population of cardiomyocytes and its neighbouring environment should not be neglected.…”

Zero‐fluoroscopy ablation with multielectrode pulse field ablation system: Case series

“…In thermal ablation modalities, however, procedural outcomes of zero-fluoroscopy approach have been shown to be comparable to the conventional fluoroscopy-based approach. 12 Over the years extensive literature has accumulated that describes benefits of using ICE. In a larger multicenter retrospective analysis Baykaner et al have described that transseptal puncture can be safely and effectively performed with ICE, without the need for fluoroscopy.…”

“…Whether the use of ICE relates to better procedural endpoints and patient outcomes in PFA compared to the conventional fluoroscopy and a more ‘’tactile’’ approach remains to be investigated. In thermal ablation modalities, however, procedural outcomes of zero‐fluoroscopy approach have been shown to be comparable to the conventional fluoroscopy‐based approach 12 …”

Experiencia inicial para la realización de ablaciones con catéter de taquicardias supraventriculares sin fluoroscopia, o casi 0-fluoroscopia en una práctica privada

“…Several studies have demonstrated that there are no significant differences in the success rate of different tachycardias ablation with any of both approaches. 2,13,[17][18][19][20] None of the patients in this series had structural heart damage, a fact that helps in the overall positive success rate, as showed in the study by Kawakami et al 21 They made extensive use of intracardiac echocardiography (ICE) and ultrasound-guided venous and atrial septal puncture (transesophageal echo), thereby obtaining a reduction in intervention-related complications. In the present cases, no further ultrasound support was required.…”

“…Prolic et al 18 showed a longer duration of the ablation procedures when performed without fluoroscopy, but Chen et al, 16 found that the difference between fluoroscopy-guided and 0-F procedures disappeared as the team acquired more experience with the navigation systems. This fact is usually attributed to the learning curve of the operators.…”