Zero Fluoroscopy Catheter Ablation of Accessory Pathways and AV Nodal Re‐Entry Tachycardia: A Single Institution Study

BACKGROUND: Minimizing radiation exposure during electrophysiological studies remains an important priority in the catheterization laboratory. With the advancement of imaging and electroanatomic mapping systems, eliminating fluoroscopy from catheter ablation of arrhythmias is becoming more feasible, even for left side procedures requiring transseptal puncture. Nevertheless, there remain concern over the safety and efficacy of a zero-fluoroscopy approach. OBJECTIVES: The aim of this report was to evaluate the safety and efficacy of a zero-fluoroscopy catheter ablation approach for accessory pathways and atrioventricular nodal-reentrant tachycardia (AVNRT) in a diverse, consecutive patient cohort. METHODS: This was a retrospective analysis of all patients who underwent radiofrequency ablation or cryoablation of accessory pathways or AVNRT between January 2019 and June 2022 at a single institution. Patient demographics, arrhythmia substrates, ablation energy modalities, and procedural outcomes were evaluated. RESULTS: There were 166 total ablation procedures performed on 164 unique patients. Fluoroscopy was not used in any of the cases. The mean age was 14.8 years (range 3.1-35.7), of whom 84% were under 18 years of age. Among the 166 procedures performed, 58 involved only typical AVNRT, 1 atypical AVNRT, 99 were accessory pathways, and 8 involved multiple arrhythmia substrates. In all, there were 112 instances of accessory pathways (78 manifest, 34 concealed). Acute procedure success was 99.4%. There were five (5/164, 3%) recurrences after a year of follow-up. There were no complications identified. CONCLUSION: Zero-fluoroscopy approach to catheter ablation of AVNRT and accessory pathways is safe and effective, further supporting the general adoption of radiation-free techniques in such cases.