Learning curve for zero-fluoroscopy catheter ablation of AVNRT: early versus late experience

Three-dimensional catheter navigation systems are being utilized more frequently to minimize or eliminate fluoroscopy during catheter ablation. We reviewed our learning curve for a zero-fluoroscopy approach over a 32-month period.

Data were obtained retrospectively from 62 consecutive patients who underwent cryoablation of AVNRT without the use of fluoroscopy from December 2005 to August 2008. The early era was defined as the first 12 months of procedures (December 2005-December 2006, n = 27) and the recent era thereafter (January 2007-August 2008, n = 35).

In the early era, acute success was achieved in 100% of patients, compared to 97% in the recent era. There were no significant complications in either group. Transient AV block was seen frequently; however, this always resolved quickly. Average procedure time for the early era was 202 minutes (100-419 minutes) compared to 160 minutes (78-332 minutes) in the recent era (P = 0.01). Recurrence rates were 15% and 8% for the early and recent era, respectively.

Procedure time significantly shortens as a function of experience. After an adequate learning curve, the procedure can be performed in a very acceptable amount of time.