Non fluoroscopic ablation of different arrhythmic structures in an electrophysiology unit. Assessment of efficiency and security

Abstract

Background

Electroanatomical mapping systems (EMS) reduce fluoroscopy dose for the ablation. Higher costs and longer procedure times are the drawbacks associated with EMS. Our objective was to validate the efficiency of the EMS.

Objective

To demonstrate that using EMS is more efficient and as secure as the traditional system of ablation.

Methods

From April 2013 to June 2018, all patients were included into two groups, according to the intention of ablation with or without fluoroscopy. Right, left, supraventricular and ventricular ablation were included. We compared procedure variables (fluoroscopy, radiofrequency and procedure times, ablation results, complication rates and costs of the procedure) that included material and detrimental effect of fluoroscopy.

Results

A total of 105 were included in the fluoroscopy group and 287 in the without fluoroscopy group. We found an important reduction in time and radiation dose in all the ablation procedures studied, without increasing the procedure time. No differences in ablation results nor complications rate were found. We found lower costs in the flutter ablation without fluoroscopy, similar costs in the right focal tachycardia ablation group and higher costs in the without fluoroscopy group for the AVNRT and left accessory pathway. When detrimental effect of fluoroscopy was added, all procedures without fluoroscopy were significantly more efficient than the ones performed with it.

Conclusions

Ablation without fluoroscopy is a technique as safe and effective as the conventional technique. Our study suggests that the radiation dose delivered to the patient and staff might be reduced, without increasing the total procedure time, being even more efficient.

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Abbreviations

AVNRT :

AV node re-entry tachycardia

CTI :

Cavo-tricuspid isthmus

AF :

Atrial fibrillation

KAP :

Kerma-area product

NAV :

Navistar® catheter

CS :

Coronary sinus

SVT :

Supraventricular tachycardia

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Correspondence to Ignacio Gil-Ortega.

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Gil-Ortega, I., Serna-Berná, A., Trujillo-Santos, A.J. et al. Non fluoroscopic ablation of different arrhythmic structures in an electrophysiology unit. Assessment of efficiency and security. Ir J Med Sci 190, 79–87 (2021). https://doi.org/10.1007/s11845-020-02247-x

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Keywords

  • Catheter ablation
  • Ionising radiation
  • Electroanatomical mapping system
  • Radiological detriment
  • Efficiency