Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance

Álvarez, Miguel; Tercedor, Luís; Almansa, Isabel Paraíso; Ros, Natàlia Carbonell; Galdeano, Ricardo Sebastián; Burillo, Francisco; Santiago, Pablo; Peñas, Rocío

doi:10.1016/j.hrthm.2009.08.037

Cited by 73 publications

(63 citation statements)

References 29 publications

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“…Alternative imaging systems, such as electroanatomic mapping and intracardiac echocardiography, have led to the ability to perform SVT ablation with no or minimal fluoroscopy, with success and complication rates similar to standard techniques (73)(74)(75)(76)(77). A reduced-fluoroscopy approach is particularly important in pediatric patients and during pregnancy (78,79).…”

Section: Basic Principles Of Electrophysiological Study Mapping Andmentioning

confidence: 99%

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

Page¹,

Joglar²,

Caldwell³

et al. 2016

Journal of the American College of Cardiology

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Section: Basic Principles Of Electrophysiological Study Mapping Andmentioning

confidence: 99%

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

Page¹,

Joglar²,

Caldwell³

et al. 2016

Journal of the American College of Cardiology

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“…This is congruent with a prospective study conducted by Alvarez et al, which involved 100 patients with AVNRT. (11) In Alvarez et al's study design, the use of fluoroscopy was totally avoided for half of their study population. Despite this, they did not observe a significant difference in the total procedure time, time spent for EP study (diagnosis time) and ablation time.…”

Section: Discussionmentioning

confidence: 99%

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

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Amora

Sheldon

et al. 2016

smedj

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INTRODUCTIONRadiofrequency catheter ablation (RFCA) is a first-line therapeutic option for supraventricular tachycardia (SVT).(1) It is conventionally performed under fluoroscopy. The amount of exposure to fluoroscopy is highly dependent on multiple variables, such as operator experience and the complexity of the arrhythmia substrate.(2) As exposure to radiation during such procedures increases the lifetime risk of fatal malignancies, skin injuries and cataract, it poses a palpable hazard to both patients and medical staff.(3) This emphasises the importance of employing all possible measures to minimise exposure to ionising radiation.Recent advances in technology have led to the development of non-fluoroscopic three-dimensional (3D) mapping systems to guide ablation during prolonged electrophysiological procedures, such as pulmonary vein isolation for atrial fibrillation and mapping of atypical atrial flutter and ventricular tachycardia. These 3D mapping systems help physicians to better comprehend complex arrhythmias and develop appropriate ablation strategies. These systems have also been proven to substantially reduce ionising radiation exposure. Data on the use of non-fluoroscopic systems (NFS) in Singapore is limited. Therefore, the aim of the present study was to determine the consistency and applicability of the aforementioned latest findings in our local setting. The specific aims of the present study were (a) to determine the procedure and fluoroscopy times, and ionising radiation exposure of patients who underwent RFCA for SVT using NFS as compared to those using conventional fluoroscopy (CF); and (b) to compare atrioventricular nodal reentrant tachycardia (AVNRT) ablation and atrioventricular reentrant tachycardia (AVRT) ablation. METHODSThe present study was a prospective analysis of patients who underwent electrophysiology (EP) study of paroxysmal SVT at our institution from January 2012 to March 2014. Patients with AVNRT and AVRT were enrolled and a total of 200 consecutive patients, aged 11-86 years, who underwent RFCA were included in this study. All patients (or parents, if the patient was underage) gave informed consent.Each patient underwent RFCA in the fasted and non-absorptive state, and under intravenous sedation with midazolam and fentanyl. Local anaesthetic with lignocaine was administered at the vascular access sites, which were the femoral venous site for all patients. Some patients also had femoral arterial access if the operator selected a retrograde aortic approach to obtain access to the left side of the heart. The decision for NFS usage was operator-dependent and made before the EP study. The choice of NFS, either EnSite TM NavX

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“…The definition of acute and chronic procedural success for this study was, in each case, based on the specific type of tachycardia in question, as is commonly the international criteria [3,8]. In particular, for the SVT CA procedures in our EP laboratory, the success was judged as the absence of arrhythmia after the procedure and absence of recurrences in the 2-to 3-month period that followed.…”

Section: Procedural Success Complications and Follow-upmentioning

confidence: 99%

“…Radiofrequency catheter ablation (CA) is currently considered to be the first-line therapy for curing many cardiac arrhythmias [3,8], and the catheter-based ablations of supraventricular tachycardia (SVT) are the most common procedures performed by paediatric electrophysiologists. These procedures are generally regarded as safe and effective, with an overall acute success rate of 95 % [23,18]; however, this treatment may require an extended use of X-ray to guide catheter manipulation during the procedure [28].…”

Section: Introductionmentioning

confidence: 99%

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

et al. 2016

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Standard imaging during electrophysiological procedures (EPs) uses fluoroscopy. The aim of this study was to evaluate the feasibility, efficacy, safety and effect of an extended use of non-fluoroscopic mapping systems (NMSs) for imaging during paediatric EPs in an adult EP laboratory focusing on the amount of X-ray exposure. This study is a retrospective analysis that includes consecutive young patients (83 pts, aged between 8 and 18) who underwent EPs from March 2005 to February 2015. We compare the fluoroscopy data of two groups of pts: Group I, pts who underwent EPs from 2005 to 2008 using only fluoroscopy and Group II, pts who underwent EPs from 2008 to 2015 performed also using NMSs. The use of an NMS resulted in reduced fluoroscopy time in Group II {median value 0.1 min (95 % CI [0.00-1.07])} compared to Group I {median value 3.55 min (95 % CI [1.93-7.83]) (MW test, P < 0.05)}. There was a complementary reduction in the total X-ray exposure from 2.53 Gy cm(2) (95 % CI [1.51-4.66]) in Group I to 0.05 Gy cm(2) in Group II (95 % CI [0.00-1.22]) (MW test, P < 0.05). Regarding ablation procedures, the median effective dose decreased from 3.04 mSv (95 % CI [1.22-6.89]) to 0.25 mSv (95 % CI [0.00-0.60]) (MW test, P < 0.05). The use of an NMS dramatically reduces fluoroscopy time and total X-ray exposure during EPs in children and teenagers in an adult EP laboratory. In our experience, this reduction is mainly related to the systematic day-to-day use of NMSs.

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Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance

Cited by 73 publications

References 29 publications

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

The Benefit of a General, Systematic Use of Mapping Systems During Electrophysiological Procedures in Children and Teenagers: The Experience of an Adult EP Laboratory

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