Key result
Zero-fluoroscopy ICE-guided catheter navigation during cryo-ablation in AVNRT patients demonstrated comparable efficacy and safety to fluoroscopic guidance, with similar mean EPS duration (101.6 vs 99.4 min) and arrhythmia recurrence (4.5% vs 8.0%).
Why the study?
Potential differences in efficacy, safety, or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation in symptomatic AVNRT patients remained to be investigated.
Does zero-fluoroscopy ICE-guided cryothermal ablation improve procedural performance and safety compared to fluoroscopy-guided ablation in symptomatic AVNRT patients?
Cohort (n=47)
No
Does zero-fluoroscopy ICE-guided cryothermal ablation improve procedural performance and safety compared to fluoroscopy-guided ablation in symptomatic AVNRT patients?
ICE-guided zero-fluoroscopy cryothermal ablation for AVNRT is feasible, safe, and effective, offering a radiation-free alternative with similar overall procedure times despite longer initial catheter placement.
Answers are grounded in this paper and cite their sources.
May offer radiation-free AVNRT ablation option; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: A new zero-fluoroscopy technique for electrophysiology catheter navigation relying on intracardiac echocardiography (ICE) has been recently reported (Ice&ICE trial). We investigated potential differences in efficacy, safety or procedural performance between conventional fluoroscopy- and ICE-guided cryothermal ablation (CA) in symptomatic AVNRT patients. METHODS: Clinical and electrophysiological data of AVNRT patients included in the Ice&ICE trial (22 patients, 16 females; =zero-fluoroscopy group) were compared to those of consecutive AVNRT patients, who underwent fluoroscopy-guided CA (25 patients, 17 females; = fluoroscopy group) during the last 2 years in our institution. EPS duration was not different between the groups (zero-fluoroscopy:101.6 ± 40.2 min, fluoroscopy:99.4 ± 37.2 min, p = n.s.). Catheter placement time was significantly shorter in the fluoroscopy group (2.2 ± 1.6 min vs. 12.0 ± 7.5 min, p < 0.05), whereas cryo-application duration (from the first cryo-mapping to the last CA) was significantly shorter in the zero-fluoroscopy group (27.5 ± 37.0 min vs. 38.1 ± 33.9 min, p < 0.05). Mean cryo-mapping and CA applications were numerically lower in the zero-fluoroscopy group (CM:7.5 ± 5.7 vs. 8.8 ± 6.2; CA:3.1 ± 1.7 vs. 3.2 ± 2.0, p = n.s.). No major adverse events occurred in both groups. After 15.0 ± 4.2 months, arrhythmia recurrence was not different between the groups (4.5% vs. 8.0%, p = n.s.). CONCLUSIONS: Zero-fluoroscopy ICE-guided EP catheter navigation shows comparable efficacy and safety to fluoroscopic guidance during CA in AVNRT patients. ICE visualization of catheters and endocardial structures within the triangle of Koch shortens the cryo-application duration, though time needed for catheter placement is longer, when compared with conventional fluoroscopic guidance, which results in similar mean EPS duration with both navigation techniques. TRIAL REGISTRATION: (German Clinical Trials Register ID: DRKS00011360 ; Registration Date 14.12.2016).
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Luani et al. (2019) conducted a cohort in Atrioventricular-nodal-reentry-tachycardia (AVNRT) (n=47). Intracardiac echocardiography (ICE) guided zero-fluoroscopy catheter navigation vs. Fluoroscopy-guided catheter navigation was evaluated on Mean EPS duration (minutes) (p=n.s.). Zero-fluoroscopy ICE-guided catheter navigation during cryo-ablation in AVNRT patients demonstrated comparable efficacy and safety to fluoroscopic guidance, with similar mean EPS duration (101.6 vs 99.4 min) and arrhythmia recurrence (4.5% vs 8.0%).
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