Search

Purpose: Safety, efficacy, and patient comfort are the primary expectations during pulmonary vein isolation (PVI). We aimed to validate the combined advantages of pre-and periprocedural anticoagulation with non-vitamin K anticoagulants (NOACs) and rigorous left atrial appendage thrombus (LAAT) exclusion with computed tomography (CT). Moreover, we assessed the effect of pre-and periprocedural workups and the catheter ablation on the patients' quality of life. Methods: Consecutive patient population was collected between March 2018 and June 2020, who underwent cardiac CT within 24 hours before PVI to plan and guide the ablation and rule out LAAT. NOAC was omitted 24 hours before the ablation. If CT was inconclusive regarding the presence of a thrombus, transoesophageal echocargiography (TOE) was performed. All patients underwent PVI using point-by-point radiofrequency ablation. All patients had a routine follow up at 3 months. Quality of life questionnaires were obtained postprocedurally to evaluate the periprocedural discomfort of the patients. Results: 187 patients (63% male) underwent CT before PVI. TOE was used in 11 (6%) cases. None of the patients experienced stroke during or after the procedure. Based on the quality of life questionnaires, the worst patient discomfort was caused by atrial fibrillation itself, followed by the TOE, then the ablation procedure, hospital stay, and finally the CT. Complication rate was low, with no symptomatic thromboembolic event and 2.1% major bleeding event. Conclusion: Omitting NOAC 24 hours before the ablation might be safe. Moreover, patient comfort may be increased by replacing the TOE examination with CT.

Purpose Our purpose was to compare the procedural characteristics, success rate, and complication rate of the conventional fluoroscopic (CF) and the zero-fluoroscopic (ZF) approach in patients undergoing catheter ablation AVNRT or typical atrial flutter (Aflu). Methods 186 consecutive patients with an indication for AVNRT or Aflu ablation were enrolled. Based on the operator's preference, the patients were assigned to either CF or ZF group. In the ZF group EnSite NavX, Carto3, or Rhythmia EAMS were used for catheter guidance. Results The median age was 56 (IQR= 42-68) years, 144 patients had AVNRT, and 42 had Aflu ablation. CF approach was chosen in 123 cases, while ZF in 63 cases. ZF approach was used more often in case of AVNRT patients [56 (39%) vs. 7 (17%), p=0.006] and in the case of female patients [43 (43%) vs. 20 (23%), p=0.025]. Acute procedural success was obtained in all cases. There was no difference in the complication rate (1 vs. 1, p>0.99) between the two groups. No difference was found regarding the procedure time between the CF and ZF groups [CF: 55 (46-60) min, ZF 60 (47-65) min; p=0.487] or in the procedure time for the different EAMS [EnSite NavX: 58 (50-63) min, Carto3: 60 (44.5-66.3) min, Rhythmia: 55 (35-69) min; p=0.887]. Similar mid-term success rate was seen in the two groups [41 (100%) vs. 96 (97%); p=0.55]. Conclusion The ZF approach demonstrated non-inferiority in safety and efficacy compared with CF for the AVNRT and Aflu ablations.