Cavotricuspid Isthmus Catheter Ablation Without the Use of Fluoroscopy as a First-Line Treatment

INTRODUCTION AND OBJECTIVES: The use of intracardiac navigation systems has enabled a significant reduction of the radiation dose in the majority of ablation procedures. The purpose of this study is to evaluate the feasibility and safety of cavotricuspid isthmus ablation without the use of fluoroscopy as a first-line treatment. METHODS AND RESULTS: An observational study without a control group in patients referred for treatment of common atrial flutter. In all of the procedures, Ensite-NavX™ was the only guidance system used to visualize the catheters. One or two diagnostic catheters and a cooled-tip ablation catheter were used in each procedure. Bidirectional cavotricuspid isthmus block was considered to indicate a successful procedure. Eighty-three ablation procedures were performed in 80 patients (82.5% men, 61 ± 10 years of age). The procedure was repeated in 3 patients (3.75%) due to flutter recurrence. Success was obtained in 98.8% of the procedures; in 1 patient it was necessary to implant a pacemaker for sinus node dysfunction and 4 patients experienced minor complications. In 75 procedures (90.4%), fluoroscopy was not required. Visualization of the diagnostic catheters was the most common reason for using fluoroscopy. The time required to perform the ablation procedure was similar to that published in other series. CONCLUSIONS: Cavotricuspid isthmus ablation using a nonfluoroscopic three-dimensional (3D) navigation system is effective and safe.