Radiofrequency ablation without the use of fluoroscopy - in what kind of patients is it feasible?

Edward Koźluk, Marcin Gawrysiak, Agnieszka Piątkowska, Piotr Lodziński, Marek Kiliszek, Sylwia Małkowska, Rajmund Zaczek, Radosław Piątkowski, Grzegorz Opolski, Dariusz Kozłowski, Edward Koźluk, Marcin Gawrysiak, Agnieszka Piątkowska, Piotr Lodziński, Marek Kiliszek, Sylwia Małkowska, Rajmund Zaczek, Radosław Piątkowski, Grzegorz Opolski, Dariusz Kozłowski

Abstract

Introduction: The aim of the study was to describe the experience in performing ablation without fluoroscopy.

Material and methods: From 575 ablation procedures with CARTO performed in the period 2003-2008, 108 (42 M; age 40 ±16 years) were done without fluoroscopy. One patient had ablation using the Localisa system. There was one man with thrombocytopenia and two pregnant women.

Results: Right ventricular (RV) outflow tract arrhythmias and other RV arrhythmias were noted in 38 patients (35%) and 17 patients (15%), respectively. There were 5 (4.6%) left ventricular (LV) outflow tract arrhythmias and 19 (17.5%) other LV tachycardias; right accessory pathways in 17 patients (20%), in the middle cardiac vein in 1, Mahaim fibres in 1, and 3 cases of permanent junctional reciprocating tachycardias. One patient with CRT had AV node ablation (Localisa). In 3 patients there were also other arrhythmias treated: slow AV nodal pathway, typical flutter isthmus and right atrial tachycardia. In 2004, 1/96 CARTO procedures was done without fluoroscopy, in 2006 2/97, in 2007 19 (2 in LV) of 93, in 2008 87 (22 in LV) of 204. The percentage of ablations without fluoroscopy in every hundred CARTO procedures was: 1%, 1%, 8%, 23%, 46%, 28% (mean 18%). There were no procedure-related complications.

Conclusions: It is feasible to perform ablations within both right and left sides of the heart without fluoroscopy. The number and type of non-fluoroscopic procedures depends on the operator's experience. Pregnant patients, with malignant history or with hematologic diseases should be ablated without fluoroscopy in centres that specialise in these kinds of procedures.

Keywords: electroanatomical system; no fluoroscopy; pregnancy; radiofrequency ablation.

Figures

Figure 1
Figure 1
Comparison of all procedures without X-ray with those performed exclusively in 2008
Figure 2
Figure 2
Potential CARTO map performed during non-fluoroscopic ablation of post-myocardial left ventricular VT in patient with anaemia because of myelodysplastic syndrome. Violet indicates healthy regions, red – low voltage regions. Brown points – places where RF application was done; red points – Purkinje potentials; blue circle – mitral annulus

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Source: PubMed

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