title: Procedural outcomes of fluoroless catheter ablation outside the traditional catheterization lab.
abstract: OBJECTIVE
  Non-ﬂuoroscopic catheter ablation is becoming routine. In experienced centres, fluoroscopy is rarely required. The use of a traditional catheterization lab (cath lab) may no longer be necessary. We began performing catheter ablations at a paediatric centre outside the traditional cardiac cath lab in 2013. The purpose of this study was to compare procedural features of paediatric catheter ablation performed outside the cath lab to those performed within a cath lab.
  
  
  RESULTS
  We prospectively looked at patients presenting to the paediatric centre with supraventricular tachycardia (SVT) undergoing catheter ablation outside the cath lab in a standard operating room (OR group). We compared retrospectively to a control group matched for age, type, and location of arrhythmia who had ablations in a traditional cath lab (CL group). Catheter visualization was exclusively by electro-anatomic mapping. Fifty-nine patients with SVT underwent catheter ablation in the OR from October 2013 to December 2015. Thirty-three patients had accessory pathways, 29 were manifest, and 13 of those were left sided. Twenty-six had atrioventricular nodal re-entrant tachycardia. Transseptal puncture with transoesophageal echocardiography guidance was used for 10 left-sided pathways, whereas the other 3 had patent foramen ovales. Procedure time did not differ significantly between groups (OR group mean 131 min, range 57-408; CL group mean 152 min, range 68-376; P = 0.12). Acute success was similar in both groups [OR group: 58/59 (98.3%) and CL group: 57/59 (96.6%)]. There were no major complications in either group. There was no fluoroscopy used in either group.
  
  
  CONCLUSIONS
  Although performing paediatric catheter ablations outside the traditional cath lab is early in our experience, we produced similar outcomes and results without encountering procedural difficulties of performing ablations in a non-conventional setting. Larger multi-centred trials will be essential to determine the feasibility of this practice.
authors.affiliation: Department of Cardiology, The Heart Center, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Amee M
authors.initials: AM
authors.lastname: Bigelow
authors.affiliation: Department of Cardiology, The Heart Center, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Smith
authors.affiliation: Department of Cardiology, The Heart Center, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Dylan T
authors.initials: DT
authors.lastname: Timberlake
authors.affiliation: Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Neil L
authors.initials: NL
authors.lastname: McNinch
authors.affiliation: Department of Cardiology, The Heart Center, Akron Children's Hospital, Akron, OH, USA.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Department of Cardiology, The Heart Center, Akron Children's Hospital, Akron, OH, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Lane
authors.affiliation: Department of Cardiology, The Heart Center, Akron Children's Hospital, Akron, OH, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Clark
mesh_terms: D000200:Action Potentials; D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006339:Heart Rate; D006801:Humans; D008297:Male; D009820:Ohio; D009873:Operating Rooms; D061646:Operative Time; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ablation; No fluoroscopy; Paediatric; Supraventricular tachycardia