Key result
Zero-fluoroscopy catheter ablation for supraventricular tachycardia achieved a 99% acute procedural success rate, comparable to the 100% success rate of conventional fluoroscopy, with similar long-term mortality.
Why the study?
Zero-fluoroscopy catheter ablation eliminates radiation exposure, but its safety, efficacy, learning-curve characteristics, long-term results, and mortality in supraventricular tachycardia ablation needed assessment.
Does zero-fluoroscopy guided catheter ablation improve safety and efficacy compared to conventional fluoroscopy in patients with supraventricular tachycardia?
Cohort (n=605)
No
Does zero-fluoroscopy guided catheter ablation improve safety and efficacy compared to conventional fluoroscopy in patients with supraventricular tachycardia?
Zero-fluoroscopy ablation for supraventricular tachycardias is as safe and acutely effective as conventional fluoroscopy, but may be associated with higher long-term recurrence rates specifically in patients with atrial flutter.
Answers are grounded in this paper and cite their sources.
Supports zero-fluoroscopy SVT ablation feasibility; hypothesis-generating and requires randomized trials before practice change.
Background and aims Zero-fluoroscopy (ZF) catheter ablation eliminates radiation exposure via use of 3-dimensional electroanatomical mapping. We aimed to assess safety and efficacy of ZF catheter ablation in the treatment of supraventricular tachycardias (SVTs), examine learning-curve characteristics and to evaluate long-term results and mortality. Methods We analysed clinical characteristics, procedural and follow-up data of 605 consecutive patients undergoing catheter ablation for SVT (atrioventricular nodal re-entry tachycardia, n = 297; atrial flutter, n = 241 and accessory pathway mediated tachycardia, n = 67) between June 2017 and September 2021. Procedures were either guided by conventional fluoroscopy (F, n = 223) or by EnSite Precision mapping system (ZF, n = 382) based on decision of the operating physician. Results Acute procedural success rate exceeded 98% across all arrhythmia groups for both ZF and F techniques (ZF: 99%, F: 100%, p = NS). 63% of patients underwent ZF procedures. Complication rate was low (0.66%), occurring only in the F group. Conversion rate to fluoroscopy was 7.8%. ZF procedures took an average of 5.1 min longer (ZF: 64.5 ± 24.3 min vs. F: 59.4 ± 29 min, p < 0.05), however ZF procedure times were reduced over time. At 3.2 years, total mortality was 7% with no significant difference between ZF and F. Deaths were not related to the procedures. Atrial flutter showed significantly higher recurrence in ZF compared to F (83% vs. 94%, p < 0.005). Conclusion Catheter ablation of SVTs using zero-fluoroscopy approach have similar acute success, complication and mortality rate as conventional fluoroscopic interventions. However, we detected significantly higher long-term arrhythmia recurrence after ZF ablation of atrial flutter, meriting further investigation.
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David et al. (2025) conducted a cohort in Supraventricular tachycardia (SVT) (n=605). Zero-fluoroscopy catheter ablation vs. Conventional fluoroscopy-guided catheter ablation was evaluated on Acute procedural success rate (p=NS). Zero-fluoroscopy catheter ablation for supraventricular tachycardia achieved a 99% acute procedural success rate, comparable to the 100% success rate of conventional fluoroscopy, with similar long-term mortality.
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