073_17092p Effects Of Ensite Navx/Precision™ Compared To Carto®3 On Fluoroscopy Exposure And Procedural Duration In Avnrt Catheter Ablation

Abstract Introduction Since arterial switch procedure replaced the Mustard and Senning (M/S) operations for D-transposition of great arteries (TGA) in 1980s, there are many M/S survivors who are now over 30 yrs old. Atrial arrhythmias are common in these patients and catheter ablation is a valid alternative to medical treatment. Purpose Assess the efficacy of atrial arrhythmia ablation using remote magnetic navigation (RMN) in M/S patients. Methods All ablations performed on patients with M/S by a single operator in a tertiary center over a 10 year period (2008–2019) were reviewed and analyzed. All documented sustained recurrences were recorded. Results Twenty-eight patients (57% M, age 41 [33–44] yrs, 2 Senning), underwent 41 procedures, 40 of which consisted of ablation for atrial tachycardia (AT, 36, 91%: 81% in PVA, 8% SVA, 11% in PVA+SVA), atrio-ventricular nodal re-entry tachycardia (1, 1%) or atrial fibrillation (AF 3, 8%). All procedures were carried out using remote navigation, electroanatomical mapping and 3D image integration. Pre-procedure echo showed at least moderately impaired systemic ventricle in 68% and moderate or severe tricuspid regurgitation in 58% of patients. Access to pulmonary venous atrium (PVA) was gained retrogradely in all cases while to access systemic venous atrium (SVA) either via femoral, subclavian or jugular veins. All except one procedure (98%) were acutely successful. At 1 and 3 years, 82% and 74% of patients were free from recurrent arrhythmia. Multiple procedures were required to control arrhythmias in 10 (36%) patients ablated for AT (60% in PVA, 30% in PVA+SVA). After the 2nd ablation 60% of these patients were in sinus rhythm at 3 years. On multivariate Cox analysis, Senning repair was associated with a higher recurrence risk after ablation compared to patients undergone a Mustard procedure (HR 1.47, p=0.01). Overall median procedural duration was 210 [155–265] min with a median fluoroscopy time of 0.9 [0.4–1.5] min and fluoroscopy exposure of 60 [43–120] μGy·m2. Conclusions Remote magnetic navigation represents a valid treatment for atrial arrhythmias in patients post M/S operation, with good short and longer-term results. Moreover, it allows the retrograde approach sparing the transbaffle puncture and enables a low fluoroscopy exposure.

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Factors associated with fluoroscopy exposure during pediatric catheter ablation utilizing electroanatomical mapping

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-012-9701-6 ◽

2012 ◽

Vol 35 (2) ◽

pp. 235-242 ◽

Cited By ~ 14

Author(s):

Grace Wan ◽

Kevin M. Shannon ◽

Jeremy P. Moore

Keyword(s):

Catheter Ablation ◽

Electroanatomical Mapping ◽

Factors Associated ◽

Fluoroscopy Exposure

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P1453Feasibility and safety of a minimal fluoroscopy approach, aiming to ALARA strategy, compared to conventional approach in a population of adult patients with high risk accessory pathways

EP Europace ◽

10.1093/europace/euaa162.271 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

V Buia ◽

D Bastian ◽

J Walascheck ◽

R Rordorf ◽

B Petracci ◽

...

Keyword(s):

High Risk ◽

Catheter Ablation ◽

Adult Population ◽

Accessory Pathway ◽

Adult Patients ◽

Catheter Position ◽

Accessory Pathways ◽

Set Up ◽

Area Product ◽

Fluoroscopy Exposure

Abstract Funding Acknowledgements None Introduction Catheter ablation is the treatment of choice for accessory pathways (AP) in high risk patients.Traditionally fluoroscopy has been the primary tool for visualizing catheter position and stability, however it has been shown that 3D electro-anatomic mapping systems (3D EAMS) can significantly reduce and even eliminate fluoroscopy exposure during catheter ablation, thus reducing the stochastic risk of malignancies. Purpose aim of our study is to assess that an ablation strategy using 3D EAMS with limited or no fluoroscopy, rigorous set-up of the X-ray equipment and intracardiac or transesofageal (TEE)echo to guide the transeptal puncture has the same degree of safety and effectiveness in ablating APs as the conventional fluoroscopic approach (CFA), and can be adopted for both right and left sided APs in the adult population,reducing the effective doses. Methods our retrospective analysis included 60 consecutive-prospective enrolled adult patients with high-risk APs treated either with a CFA in IRCCS Policlinico San Matteo (Pavia) or with a 3 EAMS guided minimally fluoroscopic approach (MFA) in Klinikum Fuerth (Fuerth) between 01/2016 and 09/2019. Results the 2 groups were homogeneous and comparable for age,sex and numbers of right/left-sided SP. In the MFA group we demonstrated the safety and feasibility of a principally 3D EAMS guided ablation approach, having the same rate of acute ablation success,while obtaining a statistically different fluoroscopy exposure time (P <0.000), dosis-area product (P< 0.000) and effective dosis (P < 0.000) compared to the CFA group. (Table) Conclusions the radiation exposure risk is cumulative and lifelong. We demonstrated that to adopt a MFA increasing the use of 3D EAMS, fluoro optminization and of TEE guided transeptal is feasible and safe forAPs ablation in adults, which will benefit of a lower or even absent fluoroscopic exposure while having the same degree of safety and efficacy of a CFA. Results Conventional Fluoroscopic Approach Minimal fluoroscopic approach P Patient (N) 31 29 n.s. Right AP 10 6 n.s. Left AP 21 23 n.s. Acute Efficacy 27 (87%) 28 (96.6%) n.s. Complication 1 (3%) 0 n.s. Fluoroscopy Time (min) 43+/-32 1.8+/-3.8 0.000 DAP (microGray*m2) 15252+/-11132 56.8+/-135.6 0.000 Effective Dosis (mSv) 30.35+/-27.7 0.09+/-0.28 0.000 AP, accessory pathway; min, minutes.

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Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure

Cardiology in the Young ◽

10.1017/s1047951119000830 ◽

2019 ◽

Vol 29 (06) ◽

pp. 793-799

Author(s):

Serhat Koca ◽

Celal Akdeniz ◽

Mehmet Karacan ◽

Volkan Tuzcu

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Three Dimensional ◽

Electroanatomic Mapping ◽

Electroanatomic Mapping System ◽

Ventricular Tachycardia Ablation ◽

Left Posterior ◽

Mapping System ◽

The Mean ◽

Fluoroscopy Exposure

AbstractIntroduction:Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group.Methods:A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients.Results:The mean patient age was 12.7 years (range 2–16), and the mean patient weight was 51 kg (range 11–84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen.Conclusions:Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.

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