Key result
Fluoroscopy-minimizing VA ablation yields similar procedural success in patients with and without structural heart disease.
Why the study?
Conventional fluoroscopy-guided catheter ablation exposes patients and staff to radiation, whereas near-zero or zero-fluoroscopy could substantially reduce or eliminate radiation exposure.
Is a fluoroscopy minimizing approach using 3D electro-anatomical mapping and intra-cardiac echocardiography safe and effective for catheter ablation of ventricular arrhythmias in patients with and without structural heart disease?
Observational (n=52)
No
Is a fluoroscopy minimizing approach using 3D electro-anatomical mapping and intra-cardiac echocardiography safe and effective for catheter ablation of ventricular arrhythmias 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.
May support fluoroscopy-minimizing VA ablation across heart disease substrates; leaves open need for randomized confirmation before practice change.
Background Conventional fluoroscopy (CF) 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 (3D) electro-anatomical mapping (EAM) system and intra-cardiac echocardiography (ICE). 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 minutes; 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 complications were low (3/60, 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.
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Jan et al. (2021) conducted an observational in Ventricular arrhythmias (n=52). Fluoroscopy minimising approach (zero/near-zero fluoroscopy) using 3D EAM and ICE vs. Structurally normal hearts (SNH) vs Structural heart disease (SHD) 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%).
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