title: Safety and Feasibility of a Minimally Fluoroscopic Approach for Ventricular Tachycardia Ablation in Patients With Structural Heart Disease: Influence of the Ventricular Tachycardia Substrate.
abstract: BACKGROUND
  We sought to evaluate the safety and feasibility of a minimally fluoroscopic approach using the CARTOUNIVU module during scar-related ventricular tachycardia (VT) ablation.
  
  
  RESULTS
  Consecutive patients with structural heart disease undergoing VT ablation using the CARTOUNIVU module were prospectively included and classified depending on their VT substrate: (1) ischemic VT (IVT) and (2) nonischemic VT and depending on the presence of an epicardial access. Radiation exposure parameters and major and minor procedure-related complications were registered. A near-zero fluoroscopy exposure was defined as those procedures with an effective dose ≤1 mSv. A total of 44 VT ablation procedures were performed in 41 patients (22 IVT and 19 nonischemic VT). The use of the CARTOUNIVU module resulted in low levels of radiation exposure: median total fluoroscopy time and effective dose of 6.08 (1.51-12.36) minutes and 2.15 (0.58-8.22) mSv, respectively. Patients with IVT had lower radiation exposure than patients with nonischemic VT (total fluoroscopy time, 2.53 [1.22-11.22] versus 8.51 [5.55-17.34] minutes; P=0.016). Epicardial access was associated with significantly higher levels of radiation exposure. Complications occurred in 4.9% patients, none of them being related to the use of the image integration tool. A near-zero fluoroscopy ablation could be performed in 14 of 44 procedures (32%), 43% of IVT procedures, and 50% of procedures with endocardial access only.
  
  
  CONCLUSIONS
  The use of the CARTOUNIVU module during scar-related VT ablation resulted in low levels of radiation exposure. A near-zero fluoroscopy approach can be achieved in up to half of the procedures, especially in IVT patients with endocardial ablation.
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.). cano_osc@gva.es.
authors: Óscar
authors: Ó
authors: Cano
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
authors: Ana
authors: A
authors: Andrés
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
authors: Joaquín
authors: J
authors: Osca
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
authors: Pau
authors: P
authors: Alonso
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
authors: María-José
authors: MJ
authors: Sancho-Tello
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
authors: José
authors: J
authors: Olagüe
authors: From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
authors: Luis
authors: L
authors: Martínez-Dolz
mesh_terms: D000200:Action Potentials; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: catheter ablation; endocardium; fluoroscopy; radiation; tachycardia, ventricular