P1453Feasibility and safety of a minimal fluoroscopy approach, aiming to ALARA strategy, compared to conventional approach in a population of adult patients with high risk accessory pathways

Abstract

Abstract Funding Acknowledgements None Introduction Catheter ablation is the treatment of choice for accessory pathways (AP) in high risk patients.Traditionally fluoroscopy has been the primary tool for visualizing catheter position and stability, however it has been shown that 3D electro-anatomic mapping systems (3D EAMS) can significantly reduce and even eliminate fluoroscopy exposure during catheter ablation, thus reducing the stochastic risk of malignancies. Purpose aim of our study is to assess that an ablation strategy using 3D EAMS with limited or no fluoroscopy, rigorous set-up of the X-ray equipment and intracardiac or transesofageal (TEE)echo to guide the transeptal puncture has the same degree of safety and effectiveness in ablating APs as the conventional fluoroscopic approach (CFA), and can be adopted for both right and left sided APs in the adult population,reducing the effective doses. Methods our retrospective analysis included 60 consecutive-prospective enrolled adult patients with high-risk APs treated either with a CFA in IRCCS Policlinico San Matteo (Pavia) or with a 3 EAMS guided minimally fluoroscopic approach (MFA) in Klinikum Fuerth (Fuerth) between 01/2016 and 09/2019. Results the 2 groups were homogeneous and comparable for age,sex and numbers of right/left-sided SP. In the MFA group we demonstrated the safety and feasibility of a principally 3D EAMS guided ablation approach, having the same rate of acute ablation success,while obtaining a statistically different fluoroscopy exposure time (P <0.000), dosis-area product (P< 0.000) and effective dosis (P < 0.000) compared to the CFA group. (Table) Conclusions the radiation exposure risk is cumulative and lifelong. We demonstrated that to adopt a MFA increasing the use of 3D EAMS, fluoro optminization and of TEE guided transeptal is feasible and safe forAPs ablation in adults, which will benefit of a lower or even absent fluoroscopic exposure while having the same degree of safety and efficacy of a CFA. Results Conventional Fluoroscopic Approach Minimal fluoroscopic approach P Patient (N) 31 29 n.s. Right AP 10 6 n.s. Left AP 21 23 n.s. Acute Efficacy 27 (87%) 28 (96.6%) n.s. Complication 1 (3%) 0 n.s. Fluoroscopy Time (min) 43+/-32 1.8+/-3.8 0.000 DAP (microGray*m2) 15252+/-11132 56.8+/-135.6 0.000 Effective Dosis (mSv) 30.35+/-27.7 0.09+/-0.28 0.000 AP, accessory pathway; min, minutes.