Key result
Zero-fluoroscopy ablation matches fluoroscopy-guided ablation for RVOT arrhythmia success and safety.
Why the study?
Zero-fluoroscopy ablation using 3D mapping is increasingly practiced globally for right ventricular outflow tract ventricular arrhythmias, but is rarely performed in Vietnam.
Does zero-fluoroscopy ablation using 3D mapping improve or maintain efficacy and safety compared to fluoroscopy-guided ablation in patients with RVOT VAs?
Cohort (n=114)
None
None
No
Does zero-fluoroscopy ablation using 3D mapping improve or maintain efficacy and safety compared to fluoroscopy-guided ablation in patients with RVOT VAs?
Absolute Event Rate: 86.8% vs 87.3%
p-value: p=0.94
Zero-fluoroscopy ablation using 3D mapping is a safe and effective alternative to conventional fluoroscopy for RVOT arrhythmias, eliminating radiation exposure without compromising success rates.
Zero-fluoroscopy 3D mapping ablation was associated with comparable RVOT outcomes; leaves open need for randomized trials before practice change.
Background: Radiofrequency catheter ablation is the preferred treatment choice for ventricular arrhythmias (VAs) originating from right ventricular outflow tract (RVOT) in symptomatic patients and is usually performed under fluoroscopy guidance. Zero-fluoroscopy (ZF) ablations using 3D mapping system applied for treatment of various types of arrhythmias are trending and practiced in many centers around the world, but rarely done in Vietnam. The objective of this study was to evaluate the efficacy and safety of zero-fluoroscopy ablation of RVOT VAs, compared with fluoroscopy-guided ablation without a 3D electroanatomic mapping (EAM) system. Methods and Results: , from May 2020 to July 2022. The patients were assigned (without randomization) to two different approaches of either zero-fluoroscopy ablation under the guidance of the Ensite system (ZF group) or fluoroscopy-guided ablation without a 3D EAM (fluoroscopy group) in a 1:1 ratio. After a follow-up time of 5.0 ± 4.9 months and 6.9 ± 9.3 months in the ZF and fluoroscopy groups, respectively, the results showed a higher success rate in the fluoroscopy group than in the complete ZF group (87.3% vs 86.8%), although the difference was not statistically significant. No major complication was noted in both the groups. Conclusion: ZF ablation for RVOT VAs can be done safely and effectively using the 3D electroanatomic mapping system. The results of ZF approach are comparable to that of the fluoroscopy-guided approach without a 3D EAM system.
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Vu et al. (2023) conducted a cohort in Ventricular arrhythmias originating from the right ventricular outflow tract (RVOT VAs) (n=114). Zero-fluoroscopy ablation using 3D electroanatomic mapping vs. Fluoroscopy-guided ablation without 3D mapping was evaluated on Freedom from VA recurrence at the end of follow-up (p=0.94). Zero-fluoroscopy ablation using 3D mapping achieved a similar success rate (86.8% vs 87.3%, p=0.94) and safety profile compared to conventional fluoroscopy-guided ablation for right ventricular outflow tract arrhythmias.
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