1. Predictors of zero X ray procedures in supraventricular arrhythmias ablation.
- Author
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Di Cori A, Zucchelli G, Segreti L, Barletta V, Viani S, Paperini L, Della Tommasina V, Cellamaro T, Vecchi A, Soldati E, and Bongiorni MG
- Subjects
- Action Potentials, Adult, Aged, Atrial Flutter diagnostic imaging, Atrial Flutter physiopathology, Electrophysiologic Techniques, Cardiac, Female, Fluoroscopy, Heart Rate, Humans, Male, Middle Aged, Occupational Exposure adverse effects, Patient Safety, Radiation Exposure adverse effects, Retrospective Studies, Risk Assessment, Risk Factors, Tachycardia, Atrioventricular Nodal Reentry diagnostic imaging, Tachycardia, Atrioventricular Nodal Reentry physiopathology, Tachycardia, Supraventricular diagnostic imaging, Tachycardia, Supraventricular physiopathology, Time Factors, Treatment Outcome, Atrial Flutter surgery, Catheter Ablation adverse effects, Occupational Exposure prevention & control, Radiation Dosage, Radiation Exposure prevention & control, Tachycardia, Atrioventricular Nodal Reentry surgery, Tachycardia, Supraventricular surgery
- Abstract
To evaluate predictors of zero-X ray procedures for supraventricular arrhythmias (SVT) using minimally fluoroscopic approach (MFA). Patients referred for RF catheter ablation of SVT were admitted for a MFA with an electro-anatomical navigation system or a conventional fluoroscopic approach (ConvA). Exclusion criterion was the need to perform a transseptal puncture. 206 patients (98 men, age 53 ± 19 years) underwent an EP study, 93 (45%) with an MFA and 113 (55%) with a ConvA. Fifty-five had no inducible arrhythmias (EPS). Fifty-four had AV nodal reentrant tachycardia (AVNRT), 49 patients had typical atrial flutter (AFL), 37 had AV reciprocating tachycardia (AVRT/WPW), 11 had focal atrial tachycardia (AT), and underwent a RF ablation. X-ray was not used at all in 51/93 (58%) procedures (zero X ray). MFA was associated with a significant reduction in total fluoroscopy time (5.5 ± 10 vs 13 ± 18 min, P = 0.01) and operator radiation dose (0.8 ± 2.5 vs 3 ± 8.2 mSV, P < 0.05). The greatest absolute dose reduction was observed in AVNRT (0.1 ± 0.3 vs 5.1 ± 10 mSV, P = 0.01, 98% relative dose reduction) and in AFL (1.3 ± 3.6 vs 11 ± 16 mSV, P = 0.003, 88% relative dose reduction) groups. Both AVNRT or AFL resulted the only statistically significant predictors of zero x ray at multivariate analysis (OR 4.5, 95% CI 1.5-13 and OR 5, 95% CI 1.7-15, P < 0.001, respectively). Success and complication rate was comparable between groups (P = NS). Using MFA for SVT ablation, radiological exposure is significantly reduced. Type of arrhythmia is the strongest predictor of zero X ray procedure.
- Published
- 2020
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