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Evaluation of a near-zero fluoroscopic approach for catheter ablation in patients with congenital heart disease

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Abstract

Purpose

Radiation exposure (RE) is a matter of concern for patients with congenital heart disease (CHD) who not infrequently need multiple interventional procedures under fluoroscopy guidance. We sought to evaluate the safety and feasibility of a minimally fluoroscopic approach in patients with CHD undergoing catheter ablation using a new image integration module (IIM).

Methods

Consecutive patients with CHD undergoing catheter ablation using the Carto Univu™ IIM were included. A near-zero fluoroscopy procedure was defined by an effective dose (ED) ≤ 1 mSv. RE parameters (total fluoroscopy time [TFT], total dose area product [tDAP], and ED), ablation outcomes, and complications were evaluated.

Results

Fifty-five patients with CHD underwent 63 ablation procedures (supraventricular tachycardia, n = 53; ventricular tachycardia, n = 10). The CHD was simple in 25%, moderate in 42%, and complex in 33%. The use of the IIM resulted in very low levels of RE (median TFT 0.13 min [IQR 0–1.04], median tDAP 54.5 cGy cm2 [IQR 9.5–176.4], median ED 0.136 mSv [IQR 0.02–0.49]). Patients with complex CHD had significantly higher RE when compared with patients with simple and moderate defects. A total of 56/63 ablation procedures (89%) were performed with an ED ≤ 1 mSv. One patient developed sinus node dysfunction requiring pacemaker implantation.

Conclusions

The use of a minimally fluoroscopic approach was safe and feasible resulting in very low RE during catheter ablation of patients with CHD. A near-zero fluoroscopy ablation was possible in up to 89% of the procedures.

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Acknowledgments

The authors would like to thank the nurse team of our Electrophysiology Laboratory (Ana García Orts, Samuel Reina de la Torre and Sonia Jiménez Cordero) for their help with patient management and acquisition of the data. We would also like to thank Elena Pérez Rafels, Gloria Pastor, and Jorge Barber from Biosense Webster for their technical assistance during the cases and during elaboration of manuscript figures.

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Authors and Affiliations

  1. Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Área de Enfermedades Cardiovasculares, Planta 4-Torre F, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain

    Óscar Cano, Assumpció Saurí, Diego Plaza, Joaquín Osca, María-José Sancho-Tello, Joaquín Rueda, Ana Osa & Luis Martínez-Dolz

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  1. Óscar Cano
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  2. Assumpció Saurí
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  3. Diego Plaza
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  4. Joaquín Osca
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Correspondence to Óscar Cano.

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Conflict of interest

Dr. Cano has received consultant fees from Biosense Webster. All other authors have nothing to disclose.

Ethical approval and informed consent

All patients signed an informed cosent and the study protocol was approved by the local ethical comittee of the Hospital Universitari i Politècnic La Fe.

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Cano, Ó., Saurí, A., Plaza, D. et al. Evaluation of a near-zero fluoroscopic approach for catheter ablation in patients with congenital heart disease. J Interv Card Electrophysiol 56, 259–269 (2019). https://doi.org/10.1007/s10840-018-0467-3

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  • DOI: https://doi.org/10.1007/s10840-018-0467-3

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