First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system

Abstract

AimsZero- and near-zero-fluoroscopic ablation techniques reduce the harmful effects of ionizing radiation during invasive electrophysiology procedures. We aimed to test the feasibility and safety of a zero-fluoroscopic strategy using a novel integrated magnetic and impedance-based electroanatomical mapping system for radiofrequency ablation (RFA) of supraventricular tachycardias (SVTs).MethodsWe retrospectively studied 92 consecutive patients undergoing electrophysiology studies with/without RFA for supraventricular tachycardia (SVT) performed by a single operator at a single center. The first 42 (Group 1) underwent a conventional fluoroscopic-guided approach and the second 50 (Group 2) underwent a zero-fluoroscopic approach using the Ensite Precision™ 3-D magnetic and impedance-based mapping system (Abbott Inc).ResultsGroup 1 comprised 14 AV-nodal re-entrant tachycardia (AVNRT), 12 typical atrial flutter, 4 accessory pathway (AP), 2 atrial tachycardia (AT), and 9 diagnostic EP studies (EPS). Group 2 comprised 16 AVNRT, 17 atrial flutter, 6 AP, 3 AT, 2 AV-nodal ablations, and 7 EPS. A complete zero-fluoroscopic approach was achieved in 94% of Group 2 patients. All procedures were acutely successful, and no complications occurred. There was a significant reduction in fluoroscopy dose, dose area product, and time (p < 0.0001, for all), with no difference in procedure times. Ablation time for typical atrial flutter was shorter in Group 2 (p = 0.006).ConclusionsA zero-fluoroscopic strategy for diagnosis and treatment of SVTs using this novel 3D-electroanatomical mapping system is feasible in majority of patients, is safe, reduces ionizing radiation exposure, and does not compromise procedural times, success rates, or complication rates.

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

“…However, ultrasound provides only 2D visualization, which restricts its usage. In contrast, 3D mapping systems have been universally used for catheter ablation [ [7][8][9]. Under the direction of EAM, the tip of the transseptal needle can be visualized.…”

Safety and Efficacy of Minimal- versus Zero-fluoroscopy Radiofrequency Catheter Ablation for Atrial Fibrillation: A Multicenter, Prospective Study

“…Indeed, case series describing minimal-fluoroscopy ablation of supraventricular tachycardia, atrial flutter, and ventricular tachycardia exist in the literature already. 25 , 26 During the study enrollment period, further advancements in CA technology and techniques have been proposed and evaluated, including high-power, short-duration ablation; the use of various balloon catheters; and the involvement of electroporation technology. 1 , 27 – 29 A minimal-fluoroscopy approach using these technologies has not yet been evaluated systematically; however, given the capability to leverage EAM and ICE with these technologies, these technologies should permit the addition of a minimal-fluoroscopy approach as well.…”

State of Fluoroless Procedures in Cardiac Electrophysiology Practice

“…However, these usually involve the reduced or minimal use of fluoroscopy, with reports of zero-fluoroscopy procedures remaining scarce. 9 Children and newborns are a special subpopulation with a higher lifelong cumulative risk of radiation-related morbidity given their longer life expectancy as compared with adults. In these very young patients, minimal or zero-fluoroscopy approaches, usually with the use of three-dimensional EAM and ICE, have been implemented earlier and more rapidly than in adult patients.…”

“…6 In the last decade, there has been a significant increase in the number of EP procedures performed with minimal or zero fluoroscopy. 1,[7][8][9] Any type of cardiac arrhythmia, including supraventricular tachycardias (SVTs), atrial fibrillation (AF), and ventricular arrhythmias (VAs), can in theory be ablated with a fluoroless approach in experienced centers. These fluoroless procedures are exceedingly significant in specific patient subpopulations who are at a higher risk of adverse effects from radiation exposure such as pregnant women, patients with obesity, and pediatric patients.…”