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Predictors of zero X ray procedures in supraventricular arrhythmias ablation.
Authors : A Di Cori (Pisa,IT), G Zucchelli (Pisa,IT), A Vecchi (Pisa,IT), V Barletta (Pisa,IT), L Segreti (Pisa,IT), S Viani (Pisa,IT), L Paperini (Pisa,IT), V Della Tommasina (Pisa,IT), T Cellamaro (Pisa,IT), M Carluccio (Pisa,IT), D Andreini (Pisa,IT), E Soldati (Pisa,IT), MG Bongiorni (Pisa,IT)
A Di Cori1
,
G Zucchelli2
,
A Vecchi2
,
V Barletta2
,
L Segreti2
,
S Viani2
,
L Paperini2
,
V Della Tommasina2
,
T Cellamaro2
,
M Carluccio2
,
D Andreini2
,
E Soldati2
,
MG Bongiorni2
,
1Santa Chiara Hospital, Department of Cardiovascular Diseases - Pisa - Italy
,
2Azienda Ospedaliero-Universitaria Pisana, Cardiac-Thoracic and Vascular Department - Pisa - Italy
,
Background: Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, predictors of zero-x ray procedures are unknown.
Purpose: To evaluate predictors of a completely non-fluoroscopic approach for supraventricular arrhythmias using the Ensite-PrecisionTM electroanatomical navigation system.
Methods: During 3 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a minimally fluoroscopic approach (MFA). Patients underwent a MFA procedure with an electro-anatomical navigation system or a conventional fluoroscopic approach (ConvA) procedure. The only exclusion criterion was the need to perform a transseptal puncture.
Results: A total of 187 patients (98 men, age 53±19 years) underwent an EP study, 88 (47%) with an MFA approach and 99 (53%) with a ConvA. Fifty-five had no inducible arrhytmias. Fifty-six had AV nodal reentrant tachycardia (AVNRT), 49 patients had typical atrial flutter (AFL), 28 had AV reciprocating tachycardia (AVRT), 1 had focal atrial tachycardia (AT), and all underwent a RF ablation. The MFA was associated with a significant reduction in total fluoroscopy time (5.5±10 vs 13±18 min, P=0.01) and operator radiation dose (0.8±2.5 vs 3±8.2 mSV, P<0.05). In the MFA group, X-ray was not used at all in 51/88 (58%) procedures (zero X ray). The greatest absolute dose reduction was observed in AVNRT (0.1± 0.3 vs 5.1± 10 mSV, P=0.01, 98% relative dose reduction) and in AFL (1.3±3.6 vs 11±16 mSV, p=0.003, 88% relative dose reduction) groups. Both AVNRT or AFL resulted the only statistically significant predictors of zero x ray at multivariate analysis (OR 4.5, 95%CI 1.5–13 and OR 5, 95%CI 1.7-15, P<0.001, respectively). Success and complication rate was comparable between groups (P=NS).
Conclusions: Efficacy and safety of MFA is comparable to ConV approach for SVT ablation. Radiological exposure is significantly reduced. Type of arrhythmia is the strongest predictor of zero x ray procedure.
