Abstract
BackgroundConventional fluoroscopy 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 electro-anatomical mapping system and intra-cardiac echocardiography. 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 min; 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 complication rate was 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.
Highlights
Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs)
The main findings of our study show that fluoroscopy minimising approach for CA procedures can be safely and efficiently performed in most patients with VAs
In a prospective study involving 227 adults with structural heart disease (SHD) (63 non-ischaemic cardiomyopathy (NICM) and 164 ischaemic cardiomyopathy (ICM)) and ventricular tachycardias (VT), Dinov et al [26] demonstrated that the non-inducibility of VT was achieved in 66.7% of NICM and in 77.4% of ICM patients that were ablated with the aid of conventional fluoroscopy (CF) combined with the 3D electro-anatomical mapping (EAM) system
Summary
Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). The use of fluoroscopy exposes patients and medical staff to potentially harmful stochastic and deterministic effects of ionising radiation [2,3,4]. Reports of near-zero (NZF) and zerofluoroscopy (ZF) procedures show that it is possible to significantly reduce or even eliminate radiation. 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) Reports of NZF or ZF approaches in CA of different forms of VAs are relatively scarce [19,20,21].
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