title: Feasibility of implementation of a "simplified, No-X-Ray, no-lead apron, two-catheter approach" for ablation of supraventricular arrhythmias in children and adults.
abstract: BACKGROUND
  Although the "near-zero-X-Ray" or "No-X-Ray" catheter ablation (CA) approach has been reported for treatment of various arrhythmias, few prospective studies have strictly used "No-X-Ray," simplified 2-catheter approaches for CA in patients with supraventricular tachycardia (SVT). We assessed the feasibility of a minimally invasive, nonfluoroscopic (MINI) CA approach in such patients.
  
  
  METHODS
  Data were obtained from a prospective multicenter CA registry of patients with regular SVTs. After femoral access, 2 catheters were used to create simple, 3D electroanatomic maps and to perform electrophysiologic studies. Medical staff did not use lead aprons after the first 10 MINI CA cases.
  
  
  RESULTS
  A total of 188 patients (age, 45 ± 21 years; 17% <19 years; 55% women) referred for the No-X-Ray approach were included. They were compared to 714 consecutive patients referred for a simplified approach using X-rays (age, 52 ± 18 years; 7% <19 years; 55% women). There were 9 protocol exceptions that necessitated the use of X-rays. Ultimately, 179/188 patients underwent the procedure without fluoroscopy, with an acute success rate of 98%. The procedure times (63 ± 26 vs. 63 ± 29 minutes, P > 0.05), major complications (0% vs. 0%, P > 0.05) and acute (98% vs. 98%, P > 0.05) and long-term (93% vs. 94%, P > 0.05) success rates were similar in the "No-X-Ray" and control groups.
  
  
  CONCLUSIONS
  Implementation of a strict "No-X-Ray, simplified 2-catheter" CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.
authors.affiliation: Department of Cardiology, Medical Center for Postgraduate Education, Grochowski Hospital, Warsaw.|ELMedica EP-Network, Kielce.|Podkarpackie Center for Cardiovascular Interventions, Sanok.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stec
authors.affiliation: ELMedica EP-Network, Kielce.|Carint Medica, Kraków.|Division of Interventional Cardiology, Center of Invasive Cardiology, Angiology and Electrotherapy in Ostrowiec, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Śledź
authors.affiliation: Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Mazij
authors.affiliation: Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Raś
authors.affiliation: Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Ludwik
authors.affiliation: ELMedica EP-Network, Kielce.|Institute of Physics, Department of Atomic Physics, Jan Kochanowski University, Kielce.
authors.forename: Michał
authors.initials: M
authors.lastname: Chrabąszcz
authors.affiliation: ELMedica EP-Network, Kielce.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Śledź
authors.affiliation: ELMedica EP-Network, Kielce.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Banasik
authors.affiliation: ELMedica EP-Network, Kielce.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bzymek
authors.affiliation: Department of Cardiology, Specialist Hospital, Tarnow.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Młynarczyk
authors.affiliation: Department of Cardiology, Medical Center for Postgraduate Education, Grochowski Hospital, Warsaw.
authors.forename: Karol
authors.initials: K
authors.lastname: Deutsch
authors.affiliation: Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw.
authors.forename: Michał
authors.initials: M
authors.lastname: Labus
authors.affiliation: Department of Cardiology and Pediatric Cardiology, Research and Development Center, Wrovasc, Voivodship's Specialist Hospital, Wroclaw.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Śpikowski
authors.affiliation: Department of Pediatric Cardiology, Silesian Medical University, Katowice, Poland.
authors.forename: Lesław
authors.initials: L
authors.lastname: Szydłowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007854:Lead; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011044:Poland; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011481:Protective Clothing; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation; D012042:Registries; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007854:Lead
keywords: ablation; electroanatomical mapping; nonfluoroscopic catheter ablation; radiation exposure; supraventricular arrhythmia