Background: Electrophysiological studies and ablation procedures expose both physicians and patients to a large amount of radiation. Most of 3-D mapping systems provide improved tracking of catheters, possibly allowing relevant reductions in radiation exposure. No data exists on the ability of the Rhythmia mapping system to minimize fluoroscopy time and dose.
Objective: To report preliminary data on feasibility and safety of a low fluoroscopic approach using the Rhythmia mapping system in SVT procedures.
Methods: Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 11 centers. For our purpose consecutive right-side procedures performed through a low fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary.
Results: This analysis included 204 cases of SVT (85 AVNRT, 75 AFL, 28 AP, 9 AT and 7 other right atrial procedures). In all the cases, diagnostic EP and ablation catheters were positioned using only the low fluoroscopic guided mapping. A total of 7157 s of fluoroscopy was needed in 204 pts (51±137 s per procedure). Sixty-nine percent of the procedures (n=141) were completed with less than 10 s of fluoroscopy, whereas in 83% (n=169) of the cases the FT was lower than 60 s. Low fluoroscopy approach with less than 10 s was less frequently obtained in case of AFL (46, 61.3%) compared to AVNRT ablation (65, 76.5%, p=0.041) whereas no differences were found comparing with AP (21, 75%, p=0.248). The median reconstructed RA volume was 94[65-133] ml in a median mapping time of 11 [6-16] min. The median number of radiofrequency ablations to terminate each arrhythmia was 5 [3-12] (total RF delivery time of 293 [180-505] s). A 100% rate of acute success was observed in our case series. No complications occurred.
Conclusion: In our preliminary experience, arrhythmias ablation through low fluoroscopy approach and the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be nearly avoided in most cases, without any reduction of the safety and effectiveness profile.