Abstract 15689: Efficacy and Safety of Non-Fluoroscopic Radiofrequency Ablation of Ventricular Arrhythmias Originating in the Sinuses of Valsalva

Abstract

Introduction: Catheter ablation (CA) for premature ventricular contractions (PVCs) coming from the sinus of Valsalva have been historically challenging due to complex anatomy and mobility of the valve cusps. More importantly, coronary angiography or aortogram was the standard or care during these procedures. Alternative imaging methods without the use of fluoroscopy have emerged as a new modality of radiofrequency ablation therapy. We sought to compare the safety and efficacy of fluoroscopy-based ablation vs. non-fluoroscopic ablation in patients who underwent CA of PVCs originating from the Sinuses of Valsalva. Methods: A retrospective analysis of 35 patients at Montefiore Medical Center who underwent CA of PVCs originating from the sinus of Valsalva was made. Considering “Use of fluoroscopy or not” as the primary grouping variable, multivariate linear and logistic regression models were created using STATA (version IC/16.1). The primary safety endpoint was absence of any procedure related complication; the primary efficacy endpoint was acute procedural success. The secondary endpoint was total procedural time. Results: Thirty-five patients underwent CA of PVCs from the right or left coronary cusps with a retrograde approach. The mean age was 62±13.6 years, with 48% being female. Eighteen (51.4 %) patients underwent a non-fluoroscopic approach. There were no differences in the primary safety and efficacy endpoints. There were no complications and all cases were successful. The mean procedural time in the non-fluoroscopic group was 138 minutes (SD=34.8) compared to 227 (SD=71) in the fluoroscopic approach (p= 0.001). When controlled for baseline characteristics in a linear regression model, fluoroscopy was the only independent association with procedural time, increasing it by 98 minutes (SE =20.4, p =0.001). Conclusion: Non-fluoroscopic CA is a feasible technique for PVCs originating from complex locations including the Sinuses of Valsalva, demonstrating similar safety and efficacy. Moreover, a fluoroless approach is associated with decreased procedural times and eliminates the risks associated with radiation exposure, thus improving lab efficiency and reducing the risks of lead associated orthopedic injuries.