Zero-fluoro atrioventricular-nodal reentrant tachycardia ablation

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Imaging

Background:

• Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger individuals.
• Radiofrequency catheter ablation (RFCA) is the standard treatment for AVNRT.
• Traditional RFCA relies on ionizing radiation (fluoroscopy) for catheter guidance, posing risks to patients and staff.

Purpose of the Study:

• To evaluate the feasibility and safety of performing zero-fluoroscopy RFCA for AVNRT.
• To assess the utility of the EnSite™ NavX™ three-dimensional (3D) electroanatomical mapping system (EAM) in radiation-free ablation procedures.

Main Methods:

• Retrospective analysis of 68 patients undergoing AVNRT-RFCA.
• Comparison between conventional fluoroscopy (convFluoro, n=30), 3D-EAM with zero fluoroscopy (zeroFluoro, n=20), and 3D-EAM with converted fluoroscopy (convertedFluoro, n=18).
• Analysis of procedure duration, fluoroscopy time and dose, and complication rates.

Main Results:

• Procedure duration was similar between convFluoro and zeroFluoro groups (74±24 min vs. 80±26 min).
• 3D-EAM significantly reduced fluoroscopy duration (7±6 min in convertedFluoro vs. 12±9 min in convFluoro).
• ZeroFluoro cases involved no radiation; all procedures showed high success rates with few minor complications and no major adverse events.

Conclusions:

• Zero-fluoroscopy RFCA for AVNRT is a safe and feasible alternative to conventional methods.
• Utilizing 3D-EAM enables significant radiation reduction for most patients.
• This approach does not prolong procedure time or increase complication risks.