Zero-fluroscopy ablation for cardiac arrhythmias: A single-center experience in Mexico

Abstract

Objective: Catheter ablation (CA) is a highly effective procedure for treating symptomatic tachyarrhythmias. However, the use of fluoroscopy, which is commonly employed in CA, exposes patients and medical personnel to ionizing radiation and its associated health risks. To address this concern, alternative techniques such as electro anatomical mapping and intracardiac ultrasound have emerged as viable options for performing CA without fluoroscopy. This study aims to describe the process and outcomes of mapping and ablation procedures performed without fluoroscopy in a Mexican electrophysiology laboratory. Methods: Fifty-two patients with arrhythmias except atrial fibrillation were included in the study. The three-dimensional mapping system ENSITE Precision (Abbott) and intracardiac ultrasound, were used when the operator deemed it necessary. We assessed complications and immediate success of catheter ablation in our patients. Results: A total of 52 patients were included in the study from January 2021 to July 2022of which 24 were men (42%) and 32 were women (57%). Only four patients received diagnostic three-dimensional mapping as a result of clinical tachycardia not being caused. An ablation of 52 arrhythmias substrates was performed with the following results: atrioventricular nodal reentry tachycardia in 20 cases (35.7%), typical atrial flutter in 16 cases (28.57%), atrioventricular re-entrant tachycardia mediated by concealed left accessory pathways in 4 cases (7%), manifest left accessory pathways in 3 cases (5.35%), manifest right accessory pathway in 2 cases (3.57%), right atrium tachycardia in 2 cases (3.8%), left atrium tachycardia in 3 cases (5.35%), right ventricular outflow tract ventricular extrasystoles in 2 cases (3.8%). The average duration of the procedure was 112.46 minutes. The immediate success rate was 100% in all ablated patients. An intracardiac ultrasound was used in 12.5% of cases. Conclusion: Catheter ablation of arrhythmias without use of fluoroscopy in our study is found to be safe and immediate success rate of 100%. By eliminating the need for fluoroscopy, this research contributes to minimizing the health risks associated with ionizing radiation exposure during CA.

Keywords

• catheter ablation
• fluoroscopy
• tachyarrhythmias
• electro anatomical mapping