Key result
Fluoroscopy-minimizing VA ablation shows similar procedural success in patients with and without structural heart disease.
Why the study?
Conventional fluoroscopy-guided catheter ablation for ventricular arrhythmias carries high radiation exposure for patients and staff, warranting evaluation of a fluoroscopy-minimising approach in patients with structurally normal hearts and structural heart disease.
Is a fluoroscopy minimizing approach for catheter ablation of ventricular arrhythmias feasible and safe in patients with and without structural heart disease?
Observational (n=52)
No
Is a fluoroscopy minimizing approach for catheter ablation of ventricular arrhythmias feasible and safe in patients with and without structural heart disease?
Absolute Event Rate: 77.4% vs 89.7%
p-value: p=0.20
A fluoroscopy-minimizing approach for catheter ablation of ventricular arrhythmias is feasible, safe, and effective in patients with both structurally normal hearts and structural heart disease.
Fluoroscopy minimization may be feasible for ventricular arrhythmia ablation across structural heart disease status; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Conventional 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). METHODS: Fifty-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. RESULTS: Sixty 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%. CONCLUSIONS: Fluoroscopy 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.
No takes yet. Share an insight, caveat, or question.
Jan et al. (2021) conducted an observational in Ventricular arrhythmias (n=52). Fluoroscopy minimising approach for catheter ablation vs. Structurally normal hearts (Group 2) vs Structural heart disease (Group 1) was evaluated on Overall procedural success rate (p=0.20). A fluoroscopy minimising approach for catheter ablation of ventricular arrhythmias achieved similar overall procedural success rates in patients with structural heart disease (77.4%) and structurally normal hearts (89.7%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: