Totally Nonfluoroscopic Approach for Interventional Arrhythmology. Single Centre Experience on More than 600 Patients

Evgenii Kropotkin, Eduard Ivanitskiy
Cardiovascular surgery. Unit 2., Federal Centre of Cardiovascular Surgery, Russia

Aim of the study: To assess safety and effectiveness of totally nonfluoroscopic approach for interventional arrhythmology procedures.

Methods and results: From march 2014 to september 2015 up to 622 patients underwent interventional arrhythmology procedures without the use of fluoroscopy. Methods used for nonfluoroscopic visualization were 3D navigation (CARTO 3) and intracardiac echo. All patients, mean age 44 + 27 years, signed informed consent and were randomized into two groups. In the first group all procedures were performed by using nonfluoroscopic approach, in the second group all procedures were performed in a routine way. All types of arrhythmology procedures were performed in both groups exept CRT - device implantation. Types of procedures without the use of fuoroscopy were: atrial fibrillation ablations (197 patients), antiarrhythmic device implantations (40 patients), ventricular arrhythmias ablation, including ventricular tachycardia and premature ventricular contraction (103 patients), supraventricular tachycardias ablations, including typical and atypical atrial flutter, atrioventricular nodal reentrant and atrioventricular reentrant tachycardias, atrial ectopic tachycardia and premature atrial contactions (282 patients). For every type of procedure performed in a nonfluoroscopic way there was a control group, where all interventions were performed uder fluoroscopic guidance. Thus total amount of patients included in study was 1253. Mean follow up period was 12 + 8 months.

Acute effectiveness of all procedures iand complication rate n both groups were comparable and didn,t differ significantly. Time of nonfuoroscopic procedures was significantly higher in nonfluoroscopic group. In nonfluoroscopic group there were no conversions to routine fluoroscopic way.

Conclusions: having the same safety and effectiveness of nonfluoroscopic approach as of a routine fluoroscopic we could additionally reveal some advantages of nonfluoroscopic approach:

1) We could safely exclude chronic exposure to low doses of ionizing radiation of all staff and patients in cath lab.

2) It became possible to exclude contrast injections for some procedures.

3) It is possible to monitor the position of ablation catheter during ablation.

4) Precise distance measurement between points.