"Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX" mapping system: Personal experience and review of the literature

Michela Casella, Gemma Pelargonio, Antonio Dello Russo, Stefania Riva, Stefano Bartoletti, Pasquale Santangeli, Antonio Scarà, Tommaso Sanna, Riccardo Proietti, Luigi Di Biase, G. Joseph Gallinghouse, Maria Lucia Narducci, Luigi Sisto, Fulvio Bellocci, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Purpose Radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias carries a small but nonnegligible radiation risk. Studies in children already showed the feasibility of using three-dimensional mapping systems as the primary guide for catheter visualization and positioning in these RFCAs. We aim to demonstrate the feasibility and safety of such an approach in young and middle-aged patients. Methods Fifty patients (age 34±12) with supraventricular tachyarrhythmias underwent electrophysiological study; of these, 47 patients proceeded to RFCA guided by the EnSite NavX™ system (23 with atrioventricular nodal reentry tachycardia, 16 with an accessory pathway, six with typical atrial flutter, and two with right atrial tachycardia). Results In 38/50 cases (76%), electroanatomical mapping avoided fluoroscopy entirely, including four cases requiring access to the left heart chambers by a retrograde approach. In the remaining 12/50 cases (24%), fluoroscopy use was limited to 122±80 s, with a correspondingly low radiation exposure (dose area product 1.3±1.1 mGy×m 2). All procedures were acutely successful, with a procedural time of 113±37 minutes, and without incurring in any major complication. Over a mean follow-up of 12±3 months, we observed one recurrence of pre-excitation and one relapse of atrial flutter. Conclusions Our study shows that non-fluoroscopic RFCA of supraventricular tachyarrhythmias using the EnSite NavXTM system is feasible, safe, and effective in a population of relatively young adults. Our experience of a non-fluoroscopic approach in these procedures deserves consideration, particularly in the young or in other patients at higher radiation risk.

Original languageEnglish (US)
Pages (from-to)109-118
Number of pages10
JournalJournal of Interventional Cardiac Electrophysiology
Volume31
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Tachycardia
Catheter Ablation
Cardiac Arrhythmias
Atrial Flutter
Fluoroscopy
Atrioventricular Nodal Reentry Tachycardia
Radiation
Recurrence
Young Adult
Catheters
Safety
Population

Keywords

  • Electroanatomical mapping
  • Radiation exposure
  • Radiofrequency ablation
  • Supraventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

"Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX" mapping system : Personal experience and review of the literature. / Casella, Michela; Pelargonio, Gemma; Russo, Antonio Dello; Riva, Stefania; Bartoletti, Stefano; Santangeli, Pasquale; Scarà, Antonio; Sanna, Tommaso; Proietti, Riccardo; Di Biase, Luigi; Gallinghouse, G. Joseph; Narducci, Maria Lucia; Sisto, Luigi; Bellocci, Fulvio; Natale, Andrea; Tondo, Claudio.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 31, No. 2, 08.2011, p. 109-118.

Research output: Contribution to journalArticle

Casella, M, Pelargonio, G, Russo, AD, Riva, S, Bartoletti, S, Santangeli, P, Scarà, A, Sanna, T, Proietti, R, Di Biase, L, Gallinghouse, GJ, Narducci, ML, Sisto, L, Bellocci, F, Natale, A & Tondo, C 2011, '"Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX" mapping system: Personal experience and review of the literature', Journal of Interventional Cardiac Electrophysiology, vol. 31, no. 2, pp. 109-118. https://doi.org/10.1007/s10840-011-9553-5
Casella, Michela ; Pelargonio, Gemma ; Russo, Antonio Dello ; Riva, Stefania ; Bartoletti, Stefano ; Santangeli, Pasquale ; Scarà, Antonio ; Sanna, Tommaso ; Proietti, Riccardo ; Di Biase, Luigi ; Gallinghouse, G. Joseph ; Narducci, Maria Lucia ; Sisto, Luigi ; Bellocci, Fulvio ; Natale, Andrea ; Tondo, Claudio. / "Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX" mapping system : Personal experience and review of the literature. In: Journal of Interventional Cardiac Electrophysiology. 2011 ; Vol. 31, No. 2. pp. 109-118.
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abstract = "Purpose Radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias carries a small but nonnegligible radiation risk. Studies in children already showed the feasibility of using three-dimensional mapping systems as the primary guide for catheter visualization and positioning in these RFCAs. We aim to demonstrate the feasibility and safety of such an approach in young and middle-aged patients. Methods Fifty patients (age 34±12) with supraventricular tachyarrhythmias underwent electrophysiological study; of these, 47 patients proceeded to RFCA guided by the EnSite NavX™ system (23 with atrioventricular nodal reentry tachycardia, 16 with an accessory pathway, six with typical atrial flutter, and two with right atrial tachycardia). Results In 38/50 cases (76{\%}), electroanatomical mapping avoided fluoroscopy entirely, including four cases requiring access to the left heart chambers by a retrograde approach. In the remaining 12/50 cases (24{\%}), fluoroscopy use was limited to 122±80 s, with a correspondingly low radiation exposure (dose area product 1.3±1.1 mGy×m 2). All procedures were acutely successful, with a procedural time of 113±37 minutes, and without incurring in any major complication. Over a mean follow-up of 12±3 months, we observed one recurrence of pre-excitation and one relapse of atrial flutter. Conclusions Our study shows that non-fluoroscopic RFCA of supraventricular tachyarrhythmias using the EnSite NavXTM system is feasible, safe, and effective in a population of relatively young adults. Our experience of a non-fluoroscopic approach in these procedures deserves consideration, particularly in the young or in other patients at higher radiation risk.",
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T1 - "Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX" mapping system

T2 - Personal experience and review of the literature

AU - Casella, Michela

AU - Pelargonio, Gemma

AU - Russo, Antonio Dello

AU - Riva, Stefania

AU - Bartoletti, Stefano

AU - Santangeli, Pasquale

AU - Scarà, Antonio

AU - Sanna, Tommaso

AU - Proietti, Riccardo

AU - Di Biase, Luigi

AU - Gallinghouse, G. Joseph

AU - Narducci, Maria Lucia

AU - Sisto, Luigi

AU - Bellocci, Fulvio

AU - Natale, Andrea

AU - Tondo, Claudio

PY - 2011/8

Y1 - 2011/8

N2 - Purpose Radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias carries a small but nonnegligible radiation risk. Studies in children already showed the feasibility of using three-dimensional mapping systems as the primary guide for catheter visualization and positioning in these RFCAs. We aim to demonstrate the feasibility and safety of such an approach in young and middle-aged patients. Methods Fifty patients (age 34±12) with supraventricular tachyarrhythmias underwent electrophysiological study; of these, 47 patients proceeded to RFCA guided by the EnSite NavX™ system (23 with atrioventricular nodal reentry tachycardia, 16 with an accessory pathway, six with typical atrial flutter, and two with right atrial tachycardia). Results In 38/50 cases (76%), electroanatomical mapping avoided fluoroscopy entirely, including four cases requiring access to the left heart chambers by a retrograde approach. In the remaining 12/50 cases (24%), fluoroscopy use was limited to 122±80 s, with a correspondingly low radiation exposure (dose area product 1.3±1.1 mGy×m 2). All procedures were acutely successful, with a procedural time of 113±37 minutes, and without incurring in any major complication. Over a mean follow-up of 12±3 months, we observed one recurrence of pre-excitation and one relapse of atrial flutter. Conclusions Our study shows that non-fluoroscopic RFCA of supraventricular tachyarrhythmias using the EnSite NavXTM system is feasible, safe, and effective in a population of relatively young adults. Our experience of a non-fluoroscopic approach in these procedures deserves consideration, particularly in the young or in other patients at higher radiation risk.

AB - Purpose Radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias carries a small but nonnegligible radiation risk. Studies in children already showed the feasibility of using three-dimensional mapping systems as the primary guide for catheter visualization and positioning in these RFCAs. We aim to demonstrate the feasibility and safety of such an approach in young and middle-aged patients. Methods Fifty patients (age 34±12) with supraventricular tachyarrhythmias underwent electrophysiological study; of these, 47 patients proceeded to RFCA guided by the EnSite NavX™ system (23 with atrioventricular nodal reentry tachycardia, 16 with an accessory pathway, six with typical atrial flutter, and two with right atrial tachycardia). Results In 38/50 cases (76%), electroanatomical mapping avoided fluoroscopy entirely, including four cases requiring access to the left heart chambers by a retrograde approach. In the remaining 12/50 cases (24%), fluoroscopy use was limited to 122±80 s, with a correspondingly low radiation exposure (dose area product 1.3±1.1 mGy×m 2). All procedures were acutely successful, with a procedural time of 113±37 minutes, and without incurring in any major complication. Over a mean follow-up of 12±3 months, we observed one recurrence of pre-excitation and one relapse of atrial flutter. Conclusions Our study shows that non-fluoroscopic RFCA of supraventricular tachyarrhythmias using the EnSite NavXTM system is feasible, safe, and effective in a population of relatively young adults. Our experience of a non-fluoroscopic approach in these procedures deserves consideration, particularly in the young or in other patients at higher radiation risk.

KW - Electroanatomical mapping

KW - Radiation exposure

KW - Radiofrequency ablation

KW - Supraventricular arrhythmias

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