P942X-ray-free 3D-mapping guided catheter ablation of premature ventricular beats is effective and possible in most patients

Introduction: in recent years number and complexity of electrophysiologic al procedures increased, and this lead to a higher cumulative radiation exposure for both patients and operators. Three-dimensional mapping systems allow precise heart chambers navigation, therefore X-Ray exposure should be minimized also during complex electrophysiological procedures for ventricular arrhythmias. We aim to describe our experience with near or zero fluoroscopy during catheter ablation of frequent monomorphic premature ventricular contractions (PVCs). Methods: Consecutive patients undergoing catheter ablation for frequent monomorphic PVCs were enrolled in this prospective single operator registry. A combination of activation (NavX Velocity/Precision, SJM) and pace mapping was used in all patients, and ablation was always carried out with an irrigated ablation catheter. Results: between Mai and December 2016 21pts [63±13 years old, 7 (30%) female] underwent catheter ablation for 23 monomorphic PVCs (11,48%: inferior Axis, LBBB; 7, 30%: inferior axis, RBBB; 1, 0.4% normal axis, RBBB; 1, 0.4% right axis, RBBB; 1, 0.4% superior axis, RBBB; 1, 0.4% superior axis, LBBB). Spontaneous or induced (orciprenalin and Theophylline) PVCs at the beginning of the study allowed for activation mapping in all patients, and after 99±34 min of procedural time acute success (mean precocity at successful ablation site -31±11msec) was achieved in all patients. PVCs were localized at: the right ventricular outflow tract (#8, 35%), the left ventricular outflow tract (#5, 22%), the aorto-mitral continuity (#6, 26%), the left ventricle close to the conduction system (#1, 0.04%) and anterior wall close to the mitral annulus (#1, 0.04%), and the right ventricle at the inferolateral wall close to the tricuspid annulus (#1, 0.04%). In 16 (76%) patients catheter ablation was carried out without fluoroscopy. In 5 (14%) patients fluoroscopy (mean X-Ray time 37±107sec, dose area product 37±114 μGy/m2, effective dose 0,07±0,22mSv) was used to achieve transseptal puncture (#3), or due to additional left ventricular substrate modification (#1, ischemic heart disease), ablation close to the conduction system (#1) or due to left coronary angiography prior and after ablation in the distal coronary sinus. Because intramyocardial/epicardial origin was often suspected ablation on both sides of the right and left ventricular outflow tract (#5), in the distal coronary sinus (#1), and high energy ablation at the aorto-mitral continuity/anterior left ventricular wall (#2) was often performed. Conclusion: X-Ray free catheter ablation of monomorphic PVCs is possible in most patients and effective.