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Efficacy and safety of zero-fluoroscopy ablation for supraventricular tachycardias

Use of optional contact force measurement for zero-fluoroscopy ablation in a clinical routine setting

Effektivität und Sicherheit der komplett strahlenfreien Katheterablation für supraventrikuläre Tachykardien

Verwendung optionaler Anpresskraftkontrolle bei der strahlenfreien Katheterablation in klinischem Routinesetting

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Abstract

Background

Conventional catheter ablation of cardiac arrhythmias is associated with radiation risks for patients and laboratory personnel. Widespread use of zero-fluoroscopic catheter ablation in clinical routine is limited by safety concerns. This study investigated the feasibility of zero-fluoroscopy catheter ablation using a three-dimensional mapping system and optional catheter contact force technology for an all-comers collective.

Patients and methods

The study comprised 184 patients; 91 patients, including 29 pediatric patients, underwent a zero-fluoroscopic electrophysiology (EP) study using the EnSite NavX system with real-time visualization of all electrodes. These patients were matched to a control group, which was treated using fluoroscopy in the same period. Inclusion criteria were documented supraventricular tachycardia or a history of symptomatic paroxysmal supraventricular tachycardia. Transseptal access, if necessary, was achieved under transesophageal echocardiographic guidance for ablation of left-sided arrhythmias. Radiofrequency (using optional contact force measurement) or a cryotechnique was used for ablation.

Results

We observed no major acute complications. There were no significant differences between the two groups in the follow-up period.

Conclusion

Zero-fluoroscopic catheter ablation is generally feasible in right-sided cardiac arrhythmias. Safety concerns regarding left atrial substrates or children can be overcome with optional real-time contact force measurement.

Zusammenfassung

Hintergrund

Die konventionelle Katheterablation von Herzrhythmusstörungen impliziert sowohl für den Patienten als auch für das behandelnde Katheterpersonal ein relevantes Strahlenschadensrisiko. Der routinemäßige, breite Einsatz einer strahlenfreien Katheterablation ist allerdings wegen Sicherheitsbedenken limitiert. Ziel dieser Studie ist es, die Durchführbarkeit einer strahlenfreien Katheterablation mittels 3-D-Mapping-System und optionaler Anpresskraftkontrolle in einem breiten Patientenkollektiv zu untersuchen.

Patienten und Methoden

184 Patienten wurden in die Studie eingeschlossen. Bei 91 Patienten, inklusive 29 pädiatrischen Patienten, wurde eine strahlenfreie EPU mittels Ensite-NavX-System durchgeführt. Diese Patienten wurden mit einer Kontrollgruppe verglichen, die mittels Durchleuchtung untersucht wurde. Einschlusskriterien waren eine dokumentierte oder anamnestische paroxysmale supraventrikuläre Tachykardie. Ein transseptaler Zugang für linksatriale Ablationen wurde unter TEE-Führung erzielt. Zur Ablationstherapie wurde entweder Radiofrequenz (mit optionaler Anpresskraftkontrolle) oder Kryotechnik eingesetzt.

Ergebnisse

Es trat keine relevante Akutkomplikation auf. Insgesamt wurde kein signifikanter Unterschied in den beiden Gruppen festgestellt.

Schlussfolgerung

Die komplett strahlenfreie Katheterablation ist generell bei rechtsatrialen Rhythmusstörungen möglich. Die Sicherheit kann bei linksatrialen Eingriffen und bei Kindern durch den Einsatz der Anpresskraftkontrolle erhöht werden.

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Authors and Affiliations

  1. Medizinische Klinik III, Eberhard Karls University Tuebingen, Universitätsklinikum Tübingen, Ottfried-Müller Str. 10, 72076, Tübingen, Germany

    P. Seizer, V. Bucher, D. Heinzmann, M. Gramlich, I. Müller, A. Henning, M. Gawaz & J. Schreieck

  2. Kinderheilkunde II, Pädiatrische Kardiologie, Eberhard Karls University Tuebingen, Tübingen, Germany

    C. Frische, M. Hofbeck & G. Kerst

Authors
  1. P. Seizer
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  2. V. Bucher
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  3. C. Frische
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  4. D. Heinzmann
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  5. M. Gramlich
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  6. I. Müller
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  7. A. Henning
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  8. M. Hofbeck
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  9. G. Kerst
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  10. M. Gawaz
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  11. J. Schreieck
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Corresponding author

Correspondence to P. Seizer.

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Conflict of interest

P. Seizer, V. Bucher, C. Frische, D. Heinzmann, M. Gramlich, I. Müller, A. Henning, M. Hofbeck, G. Kerst, M. Gawaz, and J. Schreieck state that there are no conflicts of interest.

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Seizer, P., Bucher, V., Frische, C. et al. Efficacy and safety of zero-fluoroscopy ablation for supraventricular tachycardias. Herz 41, 241–245 (2016). https://doi.org/10.1007/s00059-015-4358-4

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  • DOI: https://doi.org/10.1007/s00059-015-4358-4

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