Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping.
OBJECTIVE
The aim of this study was to quantify fluoroscopy use in catheter ablation procedures using a three-dimensional mapping system as the primary source of catheter guidance.


BACKGROUND
Three-dimensional mapping allows continuous visualization of the location of mapping and ablation catheter electrodes. It has been shown to decrease fluoroscopy times. However, the extent to which it can decrease fluoroscopy time has not been completely defined.


METHODS
Thirty patients (mean age 12.9 years; range 4-27 years) with reentrant supraventricular tachycardia underwent catheter ablation using standard protocols. Mapping was performed using the EnSite system (St. Jude Medical, St Paul, MN, USA) in the NavX mode (NavX). Eighteen patients had AVNRT, 12 had AVRT. Fluoroscopy times were compared to an age-matched and rhythm-matched control population.


RESULTS
Procedural success was achieved in 30 of 30 patients (100%). Mean procedure time was 3.27 hours (range 1.83-5.8 hours). Mean fluoroscopy time was 1.05 minutes (range 0-14.8 minutes). Twenty-four of 30 (80%) received no fluoroscopy. Mean fluoroscopy time for the control group was 21.37 minutes (range 5.13-77.13 minutes). Thus fluoroscopy time was 95% less in the study group compared to control (1.05 +/- 2.96 vs 21.37 +/- 18.35 minutes, P < 0.001).


CONCLUSIONS
NavX was used to effectively guide catheters during ablation procedures resulting in a significant decrease in fluoroscopy use. In 80% of the procedures, no fluoroscopy was used. Further advances in the technology may permit additional decreases in x-ray exposure for the 20% of patients who required it.
Smith
Grace
G
Heart Center, Division of Pediatric Cardiology, Akron Children's Hospital, Akron, Ohio 44308, USA.
Clark
John M
JM
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013617:Tachycardia, Supraventricular / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome