Minimal fluoroscopy approach for right‐sided supraventricular tachycardia ablation with a novel ablation technology: Insights from the multicenter CHARISMA clinical registry. (14th April 2021)

• Record Type: Journal Article
• Authors: Cauti, Filippo M.; Rossi, Pietro; La Greca, Carmelo; Piro, Agostino; Di Belardino, Natale; Battaglia, Alberto; Ferraris, Federico; Pecora, Domenico; Lavalle, Carlo; Scalone, Antonio; Rossi, Luca; Di Cori, Andrea; Solimene, Francesco; Mantovan, Roberto; Pedretti, Stefano; Iaia, Luigi; Bianchi, Stefano; Anselmino, Matteo
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 32:Number 5(2021)
• Page Start: 1296
• Page End: 1304
• Publication Date: 2021-04-14
• Subjects: catheter ablation -- fluoroscopy reduction -- low fluoro -- Rhythmia mapping system -- supraventricular tachycardia; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15023
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Background: No data exist on the ability of the novel Rhythmia 3‐D mapping system to minimize fluoroscopy exposure during transcatheter ablation of arrhythmias. We report data on the feasibility and safety of a minimal fluoroscopic approach using this system in supraventricular tachycardia (SVT) procedures. Methods: Consecutive patients were enrolled in the CHARISMA registry at 12 centers. All right‐sided procedures performed with the Rhythmia mapping system were analyzed. The acquired electroanatomic information was used to reconstruct 3‐D cardiac geometry; fluoroscopic confirmation was used whenever deemed necessary. Results: Three hundred twenty‐five patients (mean age = 56 ± 17 years, 57% male) were included: 152 atrioventricular nodal reentrant tachycardia, 116 atrial flutter, 41 and 16 right‐sided accessory pathway and atrial tachycardia, respectively. Overall, 27 481 s of fluoroscopy were used (84.6 ± 224 s per procedure, equivalent effective dose = 1.1 ± 3.7 mSv per patient). One hundred ninety‐two procedures (59.1%) were completed without the use of fluoroscopy (zero fluoroscopy, ZF). In multivariate analysis, the presence of a fellow in training (OR = 0.15, 95% CI: 0.05–0.46; p = .0008), radiofrequency application (0.99, 0.99–1.00; p = .0002), and mapping times (0.99, 0.99–1.00; p = .042) were all inversely associated with ZF approach. Acute procedural success was achieved in 97.8% of the cases (98.4 vs. 97% in the ZF vs. non‐ZF group; p = .4503). During a mean of 290.7 ± 169.6 days follow‐up, no major adverse events were reported, and recurrence of the primary arrhythmia was 2.5% (2.1 vs. 3% in the ZF vs. non‐ZF group; p = .7206). Conclusions: The Rhythmia mapping system permits transcatheter ablation of right‐sided SVT with minimal fluoroscopy exposure. Even more, in most cases, the system enables a ZF approach, without affecting safety and efficacy.