Zero or minimal fluoroscopy catheter ablation: feasibility, efficacy, and safety results

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Fluoroscopy has been used to guide catheter ablation since the beginning of this technique, despite its important secondary effects on both patients and operators. However, three-dimensional electroanatomic mapping systems (3D-EAMP) enable ablation of some substrates using zero or minimal fluoroscopy. The aim of this study is to explore the feasibility, efficacy and safety of a zero or minimal fluoroscopy approach in our center. METHODS: We performed a retrospective observational study with consecutive patients that underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), accessory pathways (AP), focal atrial tachycardia and typical atrial flutter in our center, between January 2020 and November 2022. Vascular access was obtained by ultrasound guidance. The objective was zero-fluoroscopy for all patients except those with left AP, in which minimal fluoroscopy was allowed for the transseptal access (ablations with retrograde aortic approach were excluded). RESULTS: 319 consecutive patients were included. 56% were male, mean age was 55 ± 16 years. The following substrates were included: AVNRT (43%), typical atrial flutter (41%), AP (12%) and focal atrial tachycardia (5%). We achieved zero-fluoroscopy use in 99.3% of right substrates, using fluoroscopy in just two cases to introduce catheters through femoral access. Mean fluoroscopy time in left AP was 6.1 minutes. Ablation was successful in 97% of cases, and we just experienced three complications (moderate pericardial effusion, femoral hematoma and femoral arteriovenous fistula, all of them solved without requiring intervention). After a mean follow- up of 17 ± 14 months, we noticed three recurrences, performing in all of them a successful second ablation procedure. Baseline characteristics and procedure details are shown in table 1. CONCLUSIONS: Catheter ablation of simple substrates with zero or minimal fluoroscopy using 3D mapping systems is feasible, effective and safe, with high success rate and low complications rate. [Figure: see text]