Zero‐fluoroscopy ablation for cardiac arrhythmias: A single‐center experience in Japan

BACKGROUND: Exposure to radiation during catheter ablation procedures poses a risk to the heath of both the patient and electrophysiology laboratory staff. Recently, the feasibility and effectiveness of zero‐fluoroscopy ablation have been reported. However, studies on the outcomes of zero‐fluoroscopy ablation in Japan remain limited. This study investigated the outcomes of zero‐fluoroscopy ablation for cardiac arrhythmias at a Japanese institute. METHODS AND RESULTS: We present a retrospective analysis of the safety, efficacy, and feasibility data from 221 consecutive patients who underwent zero‐fluoroscopy ablation. Of these patients, 181 had atrial fibrillation, 17 had paroxysmal supraventricular tachycardia, 13 had atrial tachycardia, 6 had ventricular tachycardia, and 4 had ventricular premature contractions. We performed zero‐fluoroscopy ablation using three‐dimensional electro‐anatomical mapping systems and intracardiac echocardiography imaging. Ultrasound‐guided sheath insertion was performed on all cases. Our experience includes exclusively endocardial cardiac ablations. The mean follow‐up was 24 months. The recurrence rates were 25.4% for atrial fibrillation, 5.9% for paroxysmal supraventricular tachycardia, 15.4% for atrial tachycardia, 33.3% for ventricular tachycardia, and 25% for ventricular premature contraction. Complications occurred in two patients (0.9%), and there was no occurrence of death. A fluoroscopic guide was used in three cases for the confirmation of vascular access (one case) and for complications (two cases). CONCLUSIONS: Zero‐fluoroscopy ablation was routinely performed without compromising on safety and efficacy. This approach may eliminate the exposure to radiation for all individuals involved in this procedure.