Use of three-dimensional mapping in young patients decreases radiation exposure even without a goal of zero fluoroscopy.
At present, three-dimensional mapping is often used during cardiac ablations with an explicit goal of decreasing radiation exposure; three-dimensional mapping was introduced in our institution in 2007, but not specifically to decrease fluoroscopy time. We document fluoroscopy use and catheterisation times in this setting. Data were obtained retrospectively from patients who underwent ablation for atrioventricular nodal re-entrant tachycardia from January, 2004 to December, 2011. A total of 93 patients were included in the study. Among them, 18 patients who underwent radiofrequency ablation without three-dimensional mapping were included in Group 1, 13 patients who underwent cryoablation without three-dimensional mapping were included in Group 2, and 62 patients who underwent cryoablation with three-dimensional mapping were included in Group 3. Mean fluoroscopy times differed significantly (34.3, 23.4, and 20.3 minutes, p<0.001) when all the groups were compared. Group 3 had a shorter average fluoroscopy time that did not reach significance when compared directly with Group 2 (p=0.29). An unadjusted linear regression model showed a progressive decrease in fluoroscopy time (p=0.002). Mean total catheterisation times differed significantly (180, 211, and 210 minutes, p=0.02) and were related to increased ablation times inherent to cryoablation techniques. Acute success was achieved in 89, 100, and 97% of patients (p=0.25), and chronic success was achieved in 80, 92, and 93% of patients (p=0.38). Complication rates were similar (17, 23, and 7%, p=0.14). In conclusion, three-dimensional mapping systems decrease fluoroscopy times even without an explicit goal of zero fluoroscopy. Efficacy and safety of the procedure have not changed.
1Division of Pediatric Cardiology,Children's Hospital of Pittsburgh of UPMC,Pittsburgh,Pennsylvania,United States of America.
Cheyenne
C
Beach
1Division of Pediatric Cardiology,Children's Hospital of Pittsburgh of UPMC,Pittsburgh,Pennsylvania,United States of America.
Lee
L
Beerman
1Division of Pediatric Cardiology,Children's Hospital of Pittsburgh of UPMC,Pittsburgh,Pennsylvania,United States of America.
Sharon
S
Mazzocco
2Department of Epidemiology,University of Pittsburgh Graduate School of Public Health,Pittsburgh,Pennsylvania,United States of America.
Maria M
MM
Brooks
1Division of Pediatric Cardiology,Children's Hospital of Pittsburgh of UPMC,Pittsburgh,Pennsylvania,United States of America.
Gaurav
G
Arora
D000293:Adolescent; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000009:adverse effects*; D002648:Child; D003452:Cryosurgery; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects*; D006040:Goals; D006801:Humans; D021621:Imaging, Three-Dimensional; D016014:Linear Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
Atrioventricular nodal re-entrant tachycardia; ablation; cryoablation; radiofrequency; three-dimensional mapping