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Updated: Oct 15, 2025
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Implementation of zero or near-zero fluoroscopy catheter ablation for idiopathic ventricular arrhythmia originating
Katarzyna Styczkiewicz1, Bartosz Ludwik2, Marek Styczkiewicz3
1Department of Internal Medicine, Institute of Medical Sciences, Medical College, University of Rzeszów, Al. mjr.W.Kopisto 2a, 35-310, Rzeszów, Poland. krachwal@interia.pl.
Insights
Zero-fluoroscopy radiofrequency ablation (RFA) for idiopathic ventricular arrhythmias (IVAs) from the aortic sinus cusp (ASC) is feasible and safe. With experience, this zero-fluoroscopy approach becomes preferred, showing similar outcomes to near-zero fluoroscopy methods.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Radiofrequency ablation (RFA) is a standard treatment for idiopathic ventricular arrhythmias (IVAs).
- Achieving zero-fluoroscopy (ZF) RFA for arrhythmias originating from the aortic sinus cusp (ASC) presents challenges.
- Near-zero fluoroscopy (NOX) using 3D electroanatomic mapping (3D-EAM) is an alternative approach.
Purpose of the Study:
- To evaluate the feasibility, safety, and learning curve of a zero-fluoroscopy (ZF) approach for RFA in patients with idiopathic ventricular arrhythmias originating from the aortic sinus cusp (IVA-ASC).
- To compare the outcomes of ZF RFA with the near-zero fluoroscopy (NOX) approach in IVA-ASC.
Main Methods:
- Retrospective analysis of 104 patients with IVA-ASC undergoing RFA between 2012 and 2018.
- Utilized a 3-dimensional electroanatomic (3D-EAM) system (Ensite, Velocity, Abbott, USA).
- Assessed acute, short-term, and long-term outcomes, including success rates, complications, procedure time, and fluoroscopy time.
Main Results:
- ZF RFA was successfully completed in 83% of attempted cases (62/75), with 13 cases converted to NOX.
- NOX approach achieved 100% completion (32/32).
- No significant differences in success rates or major complications were observed between ZF and NOX.
- Median procedure time was shorter for ZF (65.0 min) compared to NOX.
- Fluoroscopy time was significantly reduced in the ZF group (0.0 min) versus NOX (0-5 min).
- Preference for ZF increased from 43% in 2012-2016 to 98% in 2017-2018, correlating with reduced procedure times.
Conclusions:
- Zero-fluoroscopy RFA is a feasible and safe option for IVA-ASC, particularly for operators experienced in the NOX approach.
- With adequate training and experience, the ZF approach becomes the preferred technique.
- 3D-EAM guided ZF ablation demonstrates comparable feasibility, safety, and effectiveness to the NOX approach for IVA-ASC.
Abstract:
Complete elimination of fluoroscopy during radiofrequency ablation (RFA) of idiopathic ventricular arrhythmias (IVAs) originating from the aortic sinus cusp (ASC) is challenging. The aim was to assess the feasibility, safety and a learning curve for a zero-fluoroscopy (ZF) approach in centers using near-zero fluoroscopy (NOX) approach in IVA-ASC. Between 2012 and 2018, we retrospectively enrolled 104 IVA-ASC patients referred for ZF RFA or NOX using a 3-dimensional electroanatomic (3D-EAM) system (Ensite, Velocity, Abbott, USA). Acute, short and long-term outcomes and learning curve for the ZF were evaluated. ZF was completed in 62 of 75 cases (83%) and NOX in 32 of 32 cases (100%). In 13 cases ZF was changed to NOX. No significant differences were found in success rates between ZF and NOX, no major complications were noted. The median procedure and fluoroscopy times were 65.0 [45-81] and 0.0 [0-5] min respectively, being shorter for ZF than for NOX. With growing experience, the preference for ZF significantly increased-43% (23/54) in 2012-2016 vs 98% (52/53) in 2017-2018, with a simultaneous reduction in the procedure time. ZF ablation can be completed in almost all patients with IVA-ASC by operators with previous experience in the NOX approach, and after appropriate training, it was a preferred ablation technique. The ZF approach for IVA-ASC guided by 3D-EAM has a similar feasibility, safety, and effectiveness to the NOX approach.
