Near-zero x-ray in arrhythmia ablation using a 3-dimensional electroanatomic mapping system: A multicenter experience.
BACKGROUND
Radiation exposure related to conventional tachyarrhythmia radiofrequency catheter ablation (RFCA) carries small but not negligible stochastic and deterministic effects on health. These effects are cumulative and potentially more harmful in younger individuals. Nonfluoroscopic mapping systems can significantly reduce the radiological exposure and in some cases it can completely eliminate it.


OBJECTIVE
The aim of this study was to assess the safety, feasibility, and efficacy of a complete nonfluoroscopic approach for RFCA compared with ablation procedures performed under fluoroscopic guidance.


METHODS
RFCA was performed in 442 consecutive patients (mean age 58 ± 19 years). The first 145 patients (group 1) were treated only under fluoroscopic guidance, and the following 297 patients (group 2) were treated using a nonfluoroscopic electroanatomic mapping system (EnSite Velocity). RFCA was completely performed without fluoroscopy in 255 of 297 patients in group 2 (86%).


RESULTS
The acute success rate did not differ between group 1 and group 2 (97% vs 96%; P = .46), and there were no differences in either procedure time (87 ± 57 minutes vs 91 ± 52 minutes; P = .41) or complication rate. Fluoroscopic exposure in group 2 was significantly reduced in comparison with group 1 (14 ± 6 seconds vs 1159 ± 833 seconds; P < .0001).


CONCLUSIONS
Compared with the conventional fluoroscopic technique, the near-zero radiation (RX) approach provides similar outcomes and may significantly reduce or eliminate ionizing radiation exposure in RFCA. These reductions are achieved without altering the duration or compromising the safety and effectiveness of the procedure.
Electrophysiology Unit, Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy. Electronic address: marzia.giaccardi@asf.toscana.it.
Marzia
M
Giaccardi
Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy.
Attilio
A
Del Rosso
Electrophysiology Unit, Department of Internal Medicine, San Giuseppe Hospital, Empoli, Italy.
Vincenzo
V
Guarnaccia
Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy.
Piercarlo
P
Ballo
Cardiology Unit, Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy.
Giuseppe
G
Mascia
Cardiology Unit, Department of Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy.
Leandro
L
Chiodi
Electrophysiology Unit, Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Andrea
A
Colella
D000328:Adult; D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D061646:Operative Time; D011834:Radiation Monitoring / Q000379:methods*; D011870:Radiologic Health / Q000379:methods; D012189:Retrospective Studies; D013610:Tachycardia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
Arrhythmia; Catheter ablation; Electrophysiology; Radiation risk; Supraventricular tachycardia; Zero fluoroscopy