Long-Term Outcomes of Near-Zero Radiation Ablation of Paroxysmal Supraventricular Tachycardia

• Published in: JACC. Clinical electrophysiology Vol. 7; no. 9; pp. 1108 - 1117
• Main Authors: Bergonti, Marco, Dello Russo, Antonio, Sicuso, Rita, Ribatti, Valentina, Compagnucci, Paolo, Catto, Valentina, Gasperetti, Alessio, Zucchetti, Martina, Cellucci, Selene, Vettor, Giulia, Dessanai, Maria Antonietta, Majocchi, Benedetta, Moltrasio, Massimo, Russo, Eleonora, Stronati, Giulia, Guerra, Federico, Di Biase, Luigi, Natale, Andrea, Tondo, Claudio, Casella, Michela
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021
• Subjects: catheter ablation; electroanatomic mapping system; minimally fluoroscopic approach; near-zero fluoroscopy; supraventricular arrhythmia; minimally fluoroscopic approach; supraventricular arrhythmia; electroanatomic mapping system; AVNRT; AVRT; ConvA; MFA; catheter ablation; HR; IQR; EAM; SVT; near-zero fluoroscopy; PM; CA
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2021.02.017

This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications. Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications. A total of 618 patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA. CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA. [Display omitted]