title: Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial.
abstract: OBJECTIVE
  Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure.
  
  
  RESULTS
  We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSiteTMNavXTMnavigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0-0.08 vs. 8.87 mSv, iqr 3.67-22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0-12 vs. 859 s, iqr 545-1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 µS per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs.
  
  
  CONCLUSIONS
  This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01132274.
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy michelacasella@hotmail.com.
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.affiliation: Department of Cardiology, S. Chiara Hospital, Trento, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Del Greco
authors.affiliation: Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Zingarini
authors.affiliation: CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Piacenti
authors.affiliation: Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.affiliation: Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.|Department of Radiology, University of Oulu, Oulu, Finland.
authors.forename: Victor
authors.initials: V
authors.lastname: Casula
authors.affiliation: Department of Cardiology, S. Chiara Hospital, Trento, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marini
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pizzamiglio
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Zucchetti
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Riva
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Narducci
authors.affiliation: Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Soldati
authors.affiliation: CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Panchetti
authors.affiliation: CNR, Institute of Clinical Physiology, Fondazione G. Monasterio, Pisa, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Startari
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bencardino
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perna
authors.affiliation: Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cichocki
authors.affiliation: Department of Policy Analysis and Public Management and CERGAS, Università Bocconi, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fattore
authors.affiliation: Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Bongiorni
authors.affiliation: NU School of Medicine, Astana, Kazakhstan.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.affiliation: Texas Cardiac Arrhythmia Institute at St Davis Medical Center, Austin, TX, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
mesh_terms: D000328:Adult; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D000069079:Radiation Exposure; D013617:Tachycardia, Supraventricular / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Electroanatomical mapping; Radiation exposure; Radiofrequency ablation; Supraventricular tachycardia