Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5-Year Experience.
BACKGROUND
Catheter ablations have been traditionally performed with the use of fluoroscopic guidance, which exposes the patient and staff to the inherent risks of radiation. We have developed techniques to eliminate the use of fluoroscopy during cardiac ablations and have been performing completely fluoroless catheter ablations on our patients for over 5 years.


METHODS
We present a retrospective analysis of the safety, efficacy, and feasibility data from 500 consecutive patients who underwent nonfluoroscopic catheter ablation, targeting a total of 639 arrhythmias, including atrioventricular reciprocating tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), atrial tachycardia (AT), atrial fibrillation (AF), premature ventricular contractions (PVCs), and ventricular tachycardia (VT). We perform fluoroless ablations using intracardiac electrograms, electroanatomic mapping, and for most cases intracardiac echocardiography. Our experience includes exclusively endocardial cardiac ablations.


RESULTS
The mean follow-up was 20.5 months. Recurrence rate for AVRT was 6.5%, for AVNRT 2.5%, for macro-reentrant AT 6.4%, for focal AT 5.4%, for AF 22.6%, for PVC 6.7%, and for VT 21.4%. Major complications occurred in five patients (1.0%); minor complications occurred in three patients (0.6%). No deaths occurred. Fluoroscopy was used in one instance, for 0.3 minutes, to confirm venous access.


CONCLUSIONS
Completely fluoroless catheter ablations may be routinely performed for all endocardial ablations without compromising safety, efficacy, or procedural duration.
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Mansour
M
Razminia
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Michael Cameron
MC
Willoughby
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Hany
H
Demo
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Hesam
H
Keshmiri
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Theodore
T
Wang
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Oliver J
OJ
D'Silva
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Terry A
TA
Zheutlin
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Hakeem
H
Jibawi
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Paul
P
Okhumale
Section of Cardiology and Clinical Cardiac Electrophysiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Richard F
RF
Kehoe
D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000401:mortality* / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data; D022062:Electrophysiologic Techniques, Cardiac / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome
ablation; arrhythmia; fluoroless