Ablación con catéter no guiada por fluoroscopia. Resultados de un registro prospectivo multicéntrico / Nonfluoroscopic catheter ablation. results from a prospective multicenter registry

Introducción y objetivos: La ablación con catéter sin guía fluoroscópica es factible en la mayoría de los casos. El objetivo de nuestro registro es evaluar la factibilidad y la seguridad de la ablación no guiada por fluoroscopia en varios centros españoles. Métodos: Once hospitales incluyeron prospectivamente a, al menos, 20 pacientes afectados de un sustrato arrítmico cuyo procedimiento de ablación, a juicio de cada operador, se podía abordar sin fluoroscopia durante todo el procedimiento. No se incluyó a pacientes portadores de dispositivos intracardiacos. Electrofisiólogos de plantilla, becarios y residentes participaron en cada procedimiento de forma habitual. Resultados: Se incluyó a un total de 247 pacientes (n = 247). Se realizó ablación en 235 casos (95,2%), y en 2 casos que no se incluyeron en el análisis la fluoroscopia se utilizó como primera intención. En el 99,15% (231/233) de los procedimientos analizados el sustrato arrítmico abordado se localizaba en cavidades derechas. Se requirió fluoroscopia en 24 (10,3%), se obtuvo éxito en el 96,4% de los procedimientos y hubo complicaciones graves en 2 pacientes (0,85%). Las variables relacionadas con la necesidad de fluoroscopia fueron el centro realizador (máximo, 33,3%; mínimo, 0; p = 0,001) y el fracaso del procedimiento (el 13 frente al 2,4%; p < 0,05). Conclusiones: El registro multicéntrico muestra que la ablación sin escopia de sustratos localizados en cavidades derechas es factible en la mayoría de los procedimientos. Se necesitan estudios aleatorizados para confirmar su seguridad. La necesidad de fluoroscopia es mayor en los procedimientos sin éxito y es variable en los centros realizadores (AU)

Introduction and objectives: Nonfluoroscopic catheter ablation is feasible in most procedures. The aim of our registry was to evaluate the safety and feasibility of a zero-fluoroscopic approach to catheter ablation in several Spanish centers. Methods: Eleven centers prospectively included a minimum of 20 patients. Patients with an arrhythmic substrate deemed suitable by the operator for a zero-fluoroscopic approach throughout the procedure were recruited. Patients with intracardiac devices were not included. Attending electrophysiologists, fellows, and resident physicians participated in each procedure, as in usual care. Results: The study included 247 patients. Ablation was performed in 235 patients (95.2%). In 2 patients, who were not included in the analysis, fluoroscopy was performed as the first-line treatment. The arrhythmic substrate was located in the right chambers in most of the procedures (231 of 233 [99.15%]). Fluoroscopy was used in 24 procedures (10.3%). Catheter ablation was successful in 96.4% of the procedures and severe complications occurred in 2 patients (0.85%). Two variables were related to the need for fluoroscopy: the performing center (minimum 0% vs maximum 30.3%; P = .001) and procedural failure (13% vs 2.4%; P < .05). Conclusions: The Spanish multicenter registry reveals that a zero-fluoroscopic approach is feasible in most right-sided catheter ablation procedures. Randomized trials are necessary to confirm the safety of this approach. The need for fluoroscopy was related to procedural failure, with significant differences among performing centers (AU)

Nonfluoroscopic Catheter Ablation. Results From a Prospective Multicenter Registry.

INTRODUCTION AND OBJECTIVES: Nonfluoroscopic catheter ablation is feasible in most procedures. The aim of our registry was to evaluate the safety and feasibility of a zero-fluoroscopic approach to catheter ablation in several Spanish centers. METHODS: Eleven centers prospectively included a minimum of 20 patients. Patients with an arrhythmic substrate deemed suitable by the operator for a zero-fluoroscopic approach throughout the procedure were recruited. Patients with intracardiac devices were not included. Attending electrophysiologists, fellows, and resident physicians participated in each procedure, as in usual care. RESULTS: The study included 247 patients. Ablation was performed in 235 patients (95.2%). In 2 patients, who were not included in the analysis, fluoroscopy was performed as the first-line treatment. The arrhythmic substrate was located in the right chambers in most of the procedures (231 of 233 [99.15%]). Fluoroscopy was used in 24 procedures (10.3%). Catheter ablation was successful in 96.4% of the procedures and severe complications occurred in 2 patients (0.85%). Two variables were related to the need for fluoroscopy: the performing center (minimum 0% vs maximum 30.3%; P=.001) and procedural failure (13% vs 2.4%; P<.05). CONCLUSIONS: The Spanish multicenter registry reveals that a zero-fluoroscopic approach is feasible in most right-sided catheter ablation procedures. Randomized trials are necessary to confirm the safety of this approach. The need for fluoroscopy was related to procedural failure, with significant differences among performing centers.

Atrioventricular node ablation and permanent ventricular pacemaker implantation without fluoroscopy: use of an electroanatomic navigation system.

Non-fluoroscopy AV ablation and pacemaker implantation. Fluoroscopic guidance is the standard tool used for transvenous pacemaker implantations and for electrophysiological and ablation procedures. It implies X-ray exposure, occasionally with high dose of radiation for the patient and operator. We describe the case of a 47-year-old man with uncontrollable permanent atrial fibrillation to whom ablation of the AV conduction and a permanent ventricular pacemaker implantation were successfully performed under the guidance of an electroanatomic navigation EnSite NavX system and with no use of fluoroscopy. This case illustrates the stand-alone use of one of the new non-fluoroscopic navigation systems for a complete procedure such as AV ablation and pacemaker implantation.