B-PO05-124 USE OF INFRARED THERMOGRAPHY TO EVALUATE TEMPERATURE GRADIENTS AND CRITICAL ISOTHERMS DURING CATHETER ABLATION WITH NORMAL AND HALF-NORMAL SALINE IN A PORCINE LEFT VENTRICULAR MODEL

ZusammenfassungEs werden die Ergebnisse von Studien sowie die Protokolle laufender „Megastudien“ mit Bezug zum Vorhofflimmer-Netzwerk dargestellt. Bei den abgeschlossenen Studien handelt es sich um die Flecainide Short-Long trial (Flec-SL) und die Angiotensin-II-Rezeptorblocker in Paroxysmal Atrial FibrillationStudie (ANTIPAF). Bei den „Megastudien“ um Studien mit den Kürzeln EAST (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), CABANA (Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) und CASTLE-AF (Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation). Die Ergebnisse der Studien: Eine präventive Kurzzeittherapie nach Kardio-version ist sinnvoller als der Verzicht auf jegliche Antiarrhythmika-Nachbehandlung. Noch effektiver scheint eine antiarrhythmische Langzeit-Nachbehandlung über sechs Monate zu sein. In der ANTIPAF-Studie zeigte sich, dass bei Patienten mit paroxysmalem Vorhofflimmern (VHF) ohne strukturelle Herzkrankheit der Angiotensinrezeptorblocker Olmesartan nicht in der Lage ist, die Häufigkeit der Anfälle zu reduzieren. Wichtigstes therapeutisches Ziel ist die Verhinderung der Progression von VHF. In der EAST-Studie wird geprüft, ob eine frühzeitig eingeleitete, „aggressive“ Therapie zur Kontrolle des Herzrhythmus eher in der Lage ist, Morbidität und Mortalität von VHF zu senken als die Standardtherapie.

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Minimising radiation exposure in catheter ablation of ventricular arrhythmias

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02120-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matevž Jan ◽

David Žižek ◽

Tine Prolič Kalinšek ◽

Dimitrij Kuhelj ◽

Primož Trunk ◽

...

Keyword(s):

Catheter Ablation ◽

Radiation Exposure ◽

Ventricular Arrhythmias ◽

Major Complication ◽

Structural Heart Disease ◽

Left Ventricular ◽

Complex Nature ◽

Group 2 ◽

Procedural Outcomes ◽

Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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