PO-635-05 VENTRICULAR ARRHYTHMIA ABLATION WITHOUT FLUOROSCOPIC UTILIZATION - A SINGLE CENTER EXPERIENCE

Abstract

Utilization of fluoroscopy is common practice for ventricular arrhythmia (VA) ablation, but its use can be associated with radiation induced morbidities to both the patient and providers. Intracardiac Echocardiogram (ICE) can be helpful to minimize radiation exposure while not compromising procedural safety. To study feasibility of fluoroscopy free (FF) VA ablation using ICE. We performed a retrospective analysis of our institutional data on VA ablation performed by three providers between August 2019 to October 2021 to analyze procedural success and safety on FF VA ablation. Among total 70 patients who underwent intended FF VA ablation, 60 were FF (VT=29, PVC=31). Intracardiac echocardiography (ICE) and 3-dimensional mapping were utilized for all cases. For left sided mapping and ablation, transseptal approach was utilized in 27 (45%) and retrograde aortic approach was used in 25 (41.6%). Radiofrequency ablation was used in all patients, and concomitant cryoablation was used in 2 (6.4%) patients who underwent PVC ablation. Acute procedural success (defined as elimination of the clinical VA) was 96.5% in VT group and 90.3% in PVC group. Among remaining 10 VA ablation patients, five patients converted to fluoroscopy use due to coronary angiography (VT=2, PVC=3) and three patients due to cryoablation (VT=1, PVC=2) due to ablation site in close proximity to conduction system or coronary artery. Among patients who had VT ablation, 3 had repeat VT ablation during follow up (271 days +/- 250) and zero patient among PVC ablation group needed repeat ablation during follow up (328 days +/- 235). Importantly, there were no procedure related complication in all FF VA ablation patients. Utilizing ICE and 3-dimensional mapping in the absence of fluoroscopy is an effective and safe technique for VA ablation.