Catheter ablation of supraventricular tachycardia and atrial flutter with no or minimal use of fluoroscopy: the initial experience of a single Bulgarian center

Abstract

Introduction: Catheter ablation (CA) is an established therapy for most arrhythmias. Non-fl uoroscopic three-dimensional (3D) electroanatomic mapping systems allow ablation of supraventricular tachycardia (SVT) and atrial fl utter (AFL) with zero or near-zero fl uoroscopy (ZF/NZF). The current study aims to report our initial experience with ZF/NZF in SVT or AFL CA. Material and methods: We conducted a single-center prospective registry enrolling consecutive patients referred for CA of SVT or AFL. ZF/NZF CA was attempted in all patients using a commercially available 3D mapping system. Fluoroscopy use was allowed at any point of the procedure. Procedural characteristics and long-term outcome were analyzed. The learning curve effect was also studied. Results: Sixty-three patients (age 53.5 ± 14.1, 57% males) with SVT or AFL were enrolled. According to arrhythmia type typical AVNRT was diagnosed in 36 (57.1%) cases, right atrial fl utter in 25 (39.7%) cases, left-sided accessory pathway in 1 (1.6%) and focal right atrial tachycardia in 1 (1.6%) case. Three patients (4.8%) had two arrhythmia substrates. The procedure was performed with ZF in 49/63 cases (77.8%), while NZF was necessary in 14 (22.2%) patients with a fl uoroscopy time of 220 ± 169 sec and a dose-area product of 7556 ± 5886 mGy*cm2. Median procedural time was 88 (IQR 25-75 percentile 71.5-116) min with 22 (IQR 25-75 percentile 16-31) min of mapping time. Acute procedural success was accomplished in all patients with no periprocedural complications. Over a follow-up of 12 ± 3 months, all patients remained arrhythmia-free. There was a learning curve effect with a signifi cant reduction of procedural time (P = 0.025) and a signifi cant difference (P = 0.019) in the rate of fl uoroscopy use among different periods of the study duration. Conclusion: ZF/NZF CA of SVT and AFL is associated with high effi cacy and safety. Entirely fl uoroless CA can be performed in the vast majority of patients. It is a feasible approach associated with a detectable learning curve effect.