Implementation of zero or near-zero fluoroscopy catheter ablation for idiopathic ventricular arrhythmia originating from the aortic sinus cusp

Figures

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  Fig. 1. Example of transaortic, retrograde, 3-dimensional electroanatomic mapping in zero-fluoroscopy catheter ablation of premature ventricular complex/ventricular tachycardia originating from the junction of the left and right coronary cusps. Left (LAO) and right anterior oblique (RAO) biplane view. LM 190 denotes left main ostium (an increase in impedance to 190 Ohms as compared with the mean impedance of 140 Ohms in the aortic root). Blue balls represent the recording of the His bundle potential from the right side, green balls represent the recording of the left far-field His bundle potential, yellow balls represent the clearest recording of the His bundle potential from the cusp marked to avoid ablation in this area, red balls represent the ablation site, and finally, violet ball represents the final effective ablation site. Pink contour represents the aortic root, and yellow shadow, a decapolar catheter located in the coronary sinus. ABL tip of ablation catheter, ncc non coronary cusp, CS coronary sinus, lm 190 left main artery ostium. (Color figure online)

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  Fig. 2. Flowchart of patient enrollment to the study and follow-up. ASC aortic sinus cusp, IVA idiopathic ventricular arrhythmia, NOX near-zero fluoroscopy, RFA radiofrequency ablation, ZF zero fluoroscopy

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  Fig. 3. Ablation outcome of ablation with zero fluoroscopy or near-zero fluoroscopy for idiopathic ventricular arrhythmias from the aortic sinus cusp in the early (2012–2016) and late study period (2017–2018). The groups did not differ in success rates considering periprocedural, 1-month, and 12-month follow-up. NOX near-zero fluoroscopy, ZF zero fluoroscopy

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  Fig. 4. Difference in the preference for choosing zero over near-zero fluoroscopy between the early (2012–2016) and late study period (2017–2018). The increased preference of the operator for choosing the ZF procedure in the late study period is significantly higher. NOX near-zero fluoroscopy, ZF zero fluoroscopy

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  Fig. 5. Procedure duration depending on ablation approach and the study period. Boxes and whiskers represent medians and interquartile ranges. For ZF approach the median procedure time, comparing the early and late period, significantly decreased in the latter. NOX near-zero fluoroscopy, ZF zero fluoroscopy

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  Fig. 6. Learning curve for the zero fluoroscopy approach in ablation of idiopathic ventricular arrhythmia from the aortic sinus cusp obtained for a single operator over the study period (explanations in the text). ASC aortic sinus cusp, IVA idiopathic ventricular arrhythmia, ZF zero-fluoroscopy approach