Zero-fluoroscopy approach for ablation of supraventricular tachycardia using the Ensite NavX system: a multicenter experience

Abstract

Background: Three-dimensional electroanatomic mapping systems have demonstrated a significant reduction in radiation exposure during radiofrequency catheter ablation procedures. We aimed to investigate the safety, feasibility and efficacy of a completely zero-fluoroscopy approach for catheter ablation of supraventricular tachycardia using the Ensite NavX navigation system compared with a conventional fluoroscopy approach. Methods: A multicenter prospective non-randomized registry study was performed in seven centers from January 2013 to February 2018. Consecutive patients referred for catheter ablation of supraventricular tachycardia were assigned either to a completely zero-fluoroscopic approach (ZF) or conventional fluoroscopy approach (CF) according to the operator's preference. Patients with atrial tachycardia were excluded. Results: Totally, 1020 patients were enrolled in ZF group; 2040 patients ablated by CF approach were selected for controls. There was no significant difference between the zero-fluoroscopy group and conventional fluoroscopy group as to procedure time (60.3 ± 20.3 vs. 59.7 ± 22.6 min, P = 0.90), immediate success rate of procedure (98.8% vs. 99.2%, P = 0.22), arrhythmia recurrence (0.4% vs. 0.5%, P = 0.85), total success rate of procedure (98.4% vs. 98.8%, P = 0.39) or complications (1.1% vs. 1.5%, P = 0.41). Compared with the conventional fluoroscopy approach, the zerofluoroscopy approach provided similar outcomes without compromising the safety or efficacy of the procedure. Conclusion: The completely zero-fluoroscopy approach demonstrated safety and efficacy comparable to a conventional fluoroscopy approach for catheter ablation of supraventricular tachycardia, and mitigated radiation exposure to both patients and operators.

Minimal fluoroscopy approach for right‐sided supraventricular tachycardia ablation with a novel ablation technology: Insights from the multicenter CHARISMA clinical registry

“…The present analysis on a large, multicenter population documents feasibility of a minimal fluoroscopy routine approach with the Rhythmia mapping system for right-sided SVTs. Similarly to what achieved by other technologies, [13][14][15][16] ZF was achieved in a high number of procedures and overall radiation exposure was extremely low in all procedures. Within recorded parameters, RF applications and mapping time emerged as inversely associated with the achievement of a ZF approach.…”

“…In addition, the success rates achieved (the recurrence of the index arrhythmia over followup was 2.5%), appear extremely satisfactory and in line with previous literature. As shown with different technologies, [13][14][15][16] the positive outcomes hereby described suggest that the use of the system may also be applicable to more complex ablation procedures, such as ablation of AF, atypical flutters, or ventricular tachycardia 9,[29][30][31] . Although the aim of the manuscript was to endorse the near ZF approach with the Rhythmia system and it was not to demonstrate superiority over other mapping systems, a potential benefit of investigated technology is the completely magnetic navigation, which allows high accuracy either in mapping and ablation phases.…”

“…Over the past decades the rapid development of new electroanatomic mapping technologies is leading to significant reductions of fluoroscopy exposure, from the lowest "reasonably achievable" to more often "zero fluoroscopy" approaches. 1,26 In fact, large retrospective and prospective series have reported on safety and efficacy of several commonly used 3-D mapping systems for a wide range of arrhythmias [12][13][14][15][16][17][18] . Data on the Rhythmia, a novel 3-D mapping system, instead, are scarce, based on a limited (n = 20), single-center experience 19 .…”

“…In fact, the rapid development of new electroanatomic mapping technologies is leading to significant reductions of fluoroscopy exposure, from the lowest "reasonably achievable" to more often "zero fluoroscopy" approaches [9][10][11] . Despite large retrospective and prospective series [12][13][14][15][16][17][18] reporting on safety and efficacy for several commonly used 3-D mapping systems, only anecdotal data 19 exists on the ability, in this respect, of the novel Rhythmia™ mapping system (Boston Scientific). The aim of this study is to report data on the feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system for right-sided supraventricular tachycardia (SVT) transcatheter ablation procedures in a routine clinical setting.…”

Изоляция Устьев Легочных Вен Одномоментно С Аблацией Каватрикуспидального Перешейка Без Использования Рентгеноскопии

“…В настоящее время в интервенционном лечении нарушений ритма сердца широкие применение нашли флюороскопические системы трехмерного электроанатомического картирования для облегчения процедур катетерной абляции. Данной проблеме посвящено множество исследований [1,2,3,4,5,6,7,8,10]. Однако в данные работы не были включены пациенты с ТП.…”