Fluoroless radiofrequency and cryo-ablation of atrioventricular nodal reentry tachycardia in adults and children: a single-center experience

Jan, Matevž; Yazıcı, Mehmet; Kalinšek, Tine Prolič; Žižek, David; Kuhelj, Dimitrij; Pernat, Andrej; Lakič, Nikola

doi:10.1007/s10840-020-00791-1

Cited by 11 publications

(14 citation statements)

References 27 publications

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“…Regarding the procedural data, we found a statistically signi cant difference in procedural duration, with the mean duration being lower in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min, p = 0.002). Our ndings are in line with previous studies investigating the ZF approach in various SVTs, which reported the mean procedural duration to range from 50 to 129 minutes [6, [10][11][12][13]. Perhaps in contrast with the available literature, we found the procedural duration to be lower in almost all types of arrhythmias and locations of the substrate except in right-sided APs.…”

Section: Discussionsupporting

confidence: 91%

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233Conventional fluoroscopy guided vs zero-fluoroscopy catheter ablation of supraventricular tachycardias

et al. 2020

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Funding Acknowledgements None Introduction Conventionally, catheter movement and placement during catheter ablation (CA) is guided by X-ray fluoroscopy. In recent years, an ‘as low as reasonably possible’ principle was established to minimize the ionizing radiation dose received by the patient and the operator. Zero-fluoroscopy approach is at the extreme end of the spectrum of this principle. With exclusion of X-ray fluoroscopy, three-dimensional electroanatomical mapping system and intracardiac echocardiography are used for catheter guidance during ablation procedures. Purpose The aim of our study was to assess and compare procedural parameters and clinical outcomes of conventional X-ray fluoroscopy guided and zero-fluoroscopy CA for treatment of supraventricular tachycardias. Methods Retrospective analysis included CA procedure between April 2014 and May 2019. Five hundred and thirteen (513) patients were selected for analysis; they had confirmed diagnosis of atrioventricular nodal reentry tachycardia (AVNRT) or atrioventricular reentry tachycardia (AVRT). Patients were divided into two groups based on the use of fluoroscopy (conventional approach group - CG; zero-fluoroscopy group - ZF). Procedural data and clinical outcomes were analyzed. Two groups were compared using chi-squared test or Mann-Whithney U test when appropriate. Results There were 249 patients (44.2% males) in CG group, and 260 patients (47.5% males) in ZF group. ZF group included 113 (43.5%) pediatric patients. The groups differed in mean age (53.4 ± 16.4 years vs 30.0 ± 19.8 years (CG vs ZF), p < 0.001), postprocedural use of antiarrhythmic agents or beta blockers (55.3% vs 17.0% (CG vs ZF), p < 0.001) and type of arrhythmia (72.3% vs 60.6% AVNRT (CG vs ZF), p = 0.003). In CG group, all procedures were performed using radiofrequency (RF) energy, whereas in ZF group, cryoablation was used in 18.3% of procedures at the discretion of the operator. Mean procedural duration was longer in CG group (100.1 ± 48.8 vs 90.4 ± 83.0 minutes, p < 0.001). The mean fluroscopy time was 13.6 ± 9.3 minutes and mean dose area product was 554.1 ± 713.6 mGycm2 in the CG group. Acute success rate was higher in CG group (95.7 vs 90.7%, p = 0.027). However, the arrhythmia-free survival rate after 13.8 ± 11.0 months of follow-up was lower in the CG group (90.9 vs 96.5%, p = 0.009). Mean number of procedures per patient was 1.04 in the CG group and 1.14 in the ZF group (p < 0.001). There were no severe complications. Conclusions Zero-fluoroscopy CA of supraventricular tachycardias is associated with lower procedural success rate, but higher long-term arrhythmia-free survival rate when compared to conventional fluoroscopy guided procedures. It is possible, that these differences are stemming from somewhat different patient populations in both groups.

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Section: Discussionsupporting

confidence: 91%

“…Importantly, the reduction of radiation dose was substantial (CF; DIA: 13.9 ± 11.0 minutes; DAP: 606 ± 1003 mGym 2 ; p < 0.001). These results are in line with the ndings from previously published studies, adding to the body of evidence on the feasibility and safety of ZF SVT ablation [6, [10][11][12][13][14][15].…”

Section: Discussionsupporting

confidence: 90%

233Conventional fluoroscopy guided vs zero-fluoroscopy catheter ablation of supraventricular tachycardias

et al. 2020

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“…Consequently, our final analysis included 27 studies 7–9,16–39 (7 randomized studies and 20 observational studies analyzing 5110 patients who have AVNRT indicated for ablation. Cryoablations were performed 25 studies which categorized into 10 studies with 4‐mm tip catheter, 12 studies with 6‐mm tip catheter, and 3 studies with 8‐mm tip catheter.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 21 studies 8,9,[17][18][19][20][21][22][23][24][25][26][27][28][31][32][33]35,36,38,39 were included in the analysis of permanent AV block, involving 3894 patients. While there were no specific reports on the management of AV block, we inferred that a permanent pacemaker would likely be necessary for most cases of permanent AV block.…”

Section: Permanent Av Blockmentioning

confidence: 99%

Efficacy and safety between radiofrequency ablation and types of cryoablation catheters for atrioventricular nodal reentrant tachycardia: A Network Meta‐analysis and Systematic Review

Siranart,

Keawkanha,

Pajareya

et al. 2024

Pacing Clinical Electrophis

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IntroductionAtrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation.MethodA literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8‐mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random‐effects model of network meta‐analysis, along with p‐scores, was employed.ResultsA total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4‐mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202–2.087) when compared to nonirrigated RFA. Similarly, 6‐mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307–2.905), 8‐mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089–8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058–3.121) compared to nonirrigated RFA.ConclusionOur study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile.

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“…In recent years, reports of near-zero (NZF) and zero-uoroscopy (ZF) procedures show that it is possible to signi cantly reduce or even eliminate radiation exposure in most CA procedures. Fluoroscopy minimising approaches utilising three-dimensional (3D) electro-anatomical mapping (EAM) systems have been frequently used in children and adults with supra-ventricular tachycardias (SVTs) and in adults with AF [9][10][11][12][13][14][15][16][17][18] . However, reports of NZF or ZF approaches in CA of different forms of VAs are relatively scarce [19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

Minimising Radiation Exposure in Catheter Ablation of Ventricu-lar Arrhythmias

Jan

Žižek

Kalinšek

et al. 2021

Preprint

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BackgroundConventional fluoroscopy (CF) guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD).MethodsFifty-two (age 53.4±17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional (3D) electro-anatomical mapping (EAM) system and intra-cardiac echocardiography (ICE). Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed.ResultsSixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9±71.7 vs 123.6±42.2 minutes; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p= 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p= 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complications were low (3/60, 5%).ConclusionsFluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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Fluoroless radiofrequency and cryo-ablation of atrioventricular nodal reentry tachycardia in adults and children: a single-center experience

Cited by 11 publications

References 27 publications

233Conventional fluoroscopy guided vs zero-fluoroscopy catheter ablation of supraventricular tachycardias

233Conventional fluoroscopy guided vs zero-fluoroscopy catheter ablation of supraventricular tachycardias

Efficacy and safety between radiofrequency ablation and types of cryoablation catheters for atrioventricular nodal reentrant tachycardia: A Network Meta‐analysis and Systematic Review

Minimising Radiation Exposure in Catheter Ablation of Ventricu-lar Arrhythmias

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