Feasibility of Implementation of a “Simplified, No‐X‐Ray, No‐Lead Apron, Two‐Catheter Approach” for Ablation of Supraventricular Arrhythmias in Children and Adults

Stec, Sebastian; Śledź, Janusz; Mazij, Mariusz; Raś, Małgorzata; Ludwik, Bartosz; Chrabąszcz, Michał; Śledź, Arkadiusz; Banasik, Mirosław; Bzymek, Magdalena; Młynarczyk, Krzysztof; Deutsch, Karol; Labus, Michał; Śpikowski, Jerzy; Szydłowski, Lesław

doi:10.1111/jce.12414

Cited by 38 publications

(51 citation statements)

References 31 publications

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“…Subsequent to this, there were reports of RF ablation procedures performed entirely without the use of fluoroscopy in SVT [5,6,8,[17][18][19][20][21][22]. Casella et al [13] shows that RF ablation without the use of fluoroscopy in 38 patients with supraventricular arrhythmias (AFL, WPW syndrome, AVNRT and AT) is safe and successful.…”

Section: Discussionmentioning

confidence: 99%

“…Casella et al [13] shows that RF ablation without the use of fluoroscopy in 38 patients with supraventricular arrhythmias (AFL, WPW syndrome, AVNRT and AT) is safe and successful. In multicenter prospective registry Stec et al [21] presented that 179 of 188 procedures were done without fluoroscopy with a success rate of 98% and no major complications. Koźluk et al [22] presented safe and efficacy fluoroless ablation in the left ventricle in a patient with benign and malignant ventricular tachycardias [6].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, it was possible to perform more complex ablations with a significant reduction or even without using fluoroscopy [4][5][6][7][8][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of cryoablation without the use of fluoroscopy

et al. 2018

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“…Classic mapping involves fluoroscopy for catheter guidance and navigation; however, the medical staff are encouraged to reduce radiation exposure with the principles of as low as reasonable achievable (ALARA). [11–18] However, no study has yet combined the NXR approach and the MVG method of RFCA in CTI-dependent AFL. The purpose of this study was to compare procedural data on RFCA for CTI AFL during implementation of the NXR approach and the MVG technique.…”

Section: Introductionmentioning

confidence: 99%

Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach

Deutsch¹,

Śledź²,

Mazij³

et al. 2017

Medicine

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Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry. Consecutive patients with the first RFCA for CTI-dependent AFL were recruited. Two navigation approaches (NXR and fluoroscopy based as low as reasonable achievable [ALARA]) and 2 mapping and ablation techniques (MVG and pull-back technique [PBT]) were assessed. NXR + MVG (n = 164; age: 63.7 ± 9.5; 30% women), NXR + PBT (n = 55; age: 63.9 ± 10.7; 39% women); ALARA + MVG (n = 36; age: 64.2 ± 9.6; 39% women); and ALARA + PBT (n = 205; age: 64.7 ± 9.1; 30% women) were compared, respectively. All groups were simplified with a 2-catheter femoral approach using 8-mm gold tip catheters (Osypka AG, Germany or Biotronik, Germany) with 15 min of observation. The MVG technique was performed using step-by-step application by mapping the largest atrial signals within the CTI.Bidirectional block in CTI was achieved in 99% of all patients (P = NS, between groups). In NXR + MVG and NXR + PBT groups, the procedure time decreased (45.4 ± 17.6 and 47.2 ± 15.7 min vs. 52.6 ± 23.7 and 59.8 ± 24.0 min, P < .01) as compared to ALARA + MVG and ALARA + PBT subgroups. In NXR + MVG and NXR + PBT groups, 91% and 98% of the procedures were performed with complete elimination of fluoroscopy. The NXR approach was associated with a significant reduction in fluoroscopy exposure (from 0.2 ± 1.1 [NXR + PBT] and 0.3 ± 1.6 [NXR + MVG] to 7.7 ± 6.0 min [ALARA + MVG] and 9.1 ± 7.2 min [ALARA + PBT], P < .001). The total application time significantly decreased in the MVG technique subgroup both in NXR and ALARA (P < .01). No major complications were observed in either groups.Complete elimination of fluoroscopy is feasible, safe, and effective during RFCA of CTI in almost all AFL patients without cardiac implanted electronic devices. The most optimal method for RFCA of CTI-dependent AFL seems to be MVG; however, it required validation of optimal RFCA's parameters with clinical follow-up.

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“…18 A preprocedural ECG analysis allowed additional cardiac magnetic resonance or computed tomography to validate the anatomy of the outflow tracts, aortic cusps, and coronary arteries and to integrate it into the 3 -dimensional mapping system. Moreover, intracardiac echocardiography could be used to monitor the procedure.…”

Section: Figurementioning

confidence: 99%

Electrocardiographic algorithms to guide a management strategy of idiopathic outflow tract ventricular arrhythmias

Ludwik¹,

Deutsch²,

Mazij³

et al. 2017

Polish Archives of Internal Medicine

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Feasibility of Implementation of a “Simplified, No‐X‐Ray, No‐Lead Apron, Two‐Catheter Approach” for Ablation of Supraventricular Arrhythmias in Children and Adults

Abstract: Implementation of a strict "No-X-Ray, simplified 2-catheter" CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.

Cited by 38 publications

References 31 publications

Safety and efficacy of cryoablation without the use of fluoroscopy

Safety and efficacy of cryoablation without the use of fluoroscopy

Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach

Electrocardiographic algorithms to guide a management strategy of idiopathic outflow tract ventricular arrhythmias

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