Feasibility of zero or near zero fluoroscopy during catheter ablation procedures.

BACKGROUND: Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electroanatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a "real world" experience of a single tertiary care center. METHODS: This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE). RESULTS: Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the en- tire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy. CONCLUSIONS: This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a "real world" experience of a single tertiary care center. When fluoroscopy was required, it was limited to TSP hence keeping the radiation dose very low.

Usefulness of inducible ventricular tachycardia to predict long-term adverse outcomes in arrhythmogenic right ventricular cardiomyopathy.

The role of the electrophysiologic (EP) study for risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy is controversial. We investigated the role of inducible sustained monomorphic ventricular tachycardia (SMVT) for the prediction of an adverse outcome (AO), defined as the occurrence of cardiac death, heart transplantation, sudden cardiac death, ventricular fibrillation, ventricular tachycardia with hemodynamic compromise or syncope. Of 62 patients who fulfilled the 2010 Arrhythmogenic Right Ventricular Cardiomyopathy Task Force criteria and underwent an EP study, 30 (48%) experienced an adverse outcome during a median follow-up of 9.8 years. SMVT was inducible in 34 patients (55%), 22 (65%) of whom had an adverse outcome. In contrast, in 28 patients without inducible SMVT, 8 (29%) had an adverse outcome. Kaplan-Meier analysis showed an event-free survival benefit for patients without inducible SMVT (log-rank p = 0.008) with a cumulative survival free of an adverse outcome of 72% (95% confidence interval [CI] 56% to 92%) in the group without inducible SMVT compared to 26% (95% CI 14% to 50%) in the other group after 10 years. The inducibility of SMVT during the EP study (hazard ratio [HR] 2.99, 95% CI 1.23 to 7.27), nonadherence (HR 2.74, 95% CI 1.3 to 5.77), and heart failure New York Heart Association functional class II and III (HR 2.25, 95% CI 1.04 to 4.87) were associated with an adverse outcome on univariate Cox regression analysis. The inducibility of SMVT (HR 2.52, 95% CI 1.03 to 6.16, p = 0.043) and nonadherence (HR 2.34, 95% CI 1.1 to 4.99, p = 0.028) remained as significant predictors on multivariate analysis. This long-term observational data suggest that SMVT inducibility during EP study might predict an adverse outcome in patients with arrhythmogenic right ventricular cardiomyopathy, advocating a role for EP study in risk stratification.

Patient satisfaction and clinical outcome following outpatient radiofrequency catheter ablation of supraventricular tachycardia.

BACKGROUND: Catheter ablation is an effective and safe treatment for various arrhythmic disorders. Patients are frequently admitted for an overnight stay after the ablation procedure to monitor for possible postprocedural complications or recurrence of the arrhythmia. The aim of this study was to assess patient satisfaction in patients with supraventricular tachycardia following catheter ablation on an outpatient basis. METHODS: 243 consecutive patients (129 male, 53%; mean age 49 +/- 17 years) underwent electrophysiological study and radiofrequency catheter ablation either on an outpatient basis or a hospitalisation that included at least an overnight hospital stay (inpatient) at a university hospital. All patients were asked to complete a specially designed questionnaire that addressed patient satisfaction as well as the clinical outcome after ablation at six months. RESULTS: The ablation procedure was performed on an outpatient basis in 119 patients (49%). The long-term procedural success rate was 99%. The overall patient satisfaction with the ablation procedure and with the clinical outcome at six months was 90%. There were no significant differences between outpatient and inpatient groups with respect to ablation results and patient satisfaction. Patients in the outpatient group returned to work after 2.8 +/- 1.9 days as compared to 3.9 +/- 2.2 days in the in hospital group (p = 0.001). CONCLUSION: Overall patient satisfaction and self-reported clinical outcome are comparable for outpatient and inpatient catheter ablations. Patients undergoing outpatient procedures may return to work earlier. Therefore, outpatient ablation procedures may be considered for selected patients without significant comorbidities.